NGS Medicare E/M Claim Submission Change

National Government Services (NGS) recently announced a change in Medicare claim submissions for E/M services performed by Non-Physician Practitioners (NPPs). Claims may be billed for E/M codes on same Date of Service (DOS) with different diagnosis codes when submitted by JK and J6 providers and groups for services by NPs (NP-Specialty 50) and PAs (PA-Specialty 97) as the Rendering/Billing Provider. The submission change will take effect for claims with a DOS on or after September 15, 2018.

E/M codes for services rendered on the same DOS will be identified by adding a 2-digit specialty code for the NPP in the 2300 or 2400 Loop NTE Segment on electronic claims or Box 19 on paper claims. NGS advises avoiding adding additional information in Box 19 beyond the Provider specialty code when possible.

Currently, this is the only change in submitting claims. All other guidelines for submitting E/M claims for NPs and PAs remain the same.

Any claims related to this issue that have been denied for services prior to September 15, 2018 should not be re-submitted. Continue to use the established redetermination process to request re-evaluation of such claims.

Claims submitted for the same DOS that do not meet the criteria will continue to be denied. Such claims may be submitted for redetermination according to the standard process.

NGS implements this change effective September 15, 2018 where it administrates Medicare, but it is expected that CMS will adopt this change across Medicare, with other Payers following suit soon thereafter.

NGS encourages Providers to adopt this process as soon as possible to avoid a delay in submitting claims or to cause a denial.

PHI Medical Office Solutions is committed to providing our clients with the highest quality solutions. In response to this change, we have integrated the changes into our claims. An additional field has been added to the Provider section where users will select the Provider’s Specialty. The change has been published in the most recent update.