Wondering why your claims for Vancomycin® injections aren’t being paid? According to a notice posted on TrailBlazer Health Enterprise’s website, the Centers for Medicare & Medicaid Services (CMS) has instructed Medicare contractors to hold 72X Type of Bill claims with dates of service on or after Jan. 1, 2012 containing HCPCS Level II code J3370 Injection, vancomycin hcl, 500 mg and modifier AY Item or service furnished to an ESRD patient that is not for the treatment of ESRD.
“Vancomycin is used to treat colitis (inflammation of the intestine caused by certain bacteria) that may occur after antibiotic treatment,” according to PubMed Health.
CMS recently discovered that payments for the drug have not been applying coinsurance and deductible amounts correctly for End Stage Renal Disease Prospective Payment System (ESRD PPS) providers since April 2.
Medicare contractors will release held claims as soon as the Fiscal Intermediary Shared System (FISS) maintainer corrects the problem. A system fix is expected to be in place by May 7. Providers do not need to take any action.
Note: TrailBlazer is suspending affected ESRD claims in location SMAP40 with reason code WW040.
Source: TrailBlazer Health Enterprises, LLC
April 27th, 2012
A quarterly update to the End Stage Renal Disease Prospective Payment System (ESRD PPS) includes a couple of corrections that will require suppliers of durable medical equipment (DME) to check their claims for overpayments. Several DME supply codes have been removed from the consolidated billing edits list and added to the list of codes not payable to DME suppliers.
July 29th, 2011