Gender Conflict Edit
A gender conflict occurs when the provider assigns a gender specific procedure to a patient of the opposite gender .
The edit comment may indicate “ PROCEDURE XXXXX IS NOT INDICATED FOR A MALE ” or “ PROCEDURE XXXXX IS NOT INDICATED FOR A FEMALE ”
Medicare Sequestration
In 2011 and 2012 , Congress passed laws requiring a reduction in federal government spending under Title I of the Budget Control Act of 2011 ( Public Law 112-25 ) and Title IX of the American Taxpayer Relief Act of 2012 ( Public Law 112-240 ), 2 U . S . C . §§ 901 , 901a . On May 1 , 2013 The White House Office of the Press Secretary issued a Presidential Sequestration Order for Fiscal Year 2013 Pursuant to Section 251A of the Balanced Budget and Emergency Deficit Control Act , As Amended .
On March 22 , 2013 , CMS released sequestration guidance notifying MAOs ( and other groups ) that beginning April 1 , 2013 , payments made to those groups would be reduced by 2 % in accordance with the Balanced Budget and Emergency Deficit Control Act of 1985 .
On May 1 , 2013 , MCS issued a second sequestration memorandum explaining the impact of the Sequestration Law on MAOs .
On July 12 , 2013 Hometown Health d / b / a Senior Care Plus notified providers of the implementation of sequestration payment adjustments . This payment policy will apply to payments made by Hometown Health d / b / a Senior Care Plus for covered items and services supplied to members covered by Senior Care Plus a Medicare Advantage plan . The 2 % sequestration payment adjustment will be applied at the final payment level after all other edits , rules and adjustments have been applied .
Unlisted or Unclassified CPT Codes
An unlisted code may be submitted for a procedure or service that does not have a valid , more descriptive CPT or HCPC code assigned . If you must bill one of these codes , it is important to give us a complete description of the service provided such as : what the code is being used for ; procedure report for unlisted surgical / procedure ; invoice for unlisted DME / supplies codes and NDC #; or dose and route of administration for unlisted drug codes . Documentation will be reviewed for appropriate coding , existence of a more appropriate code , coverage and reimbursement allowance . Reimbursement for these codes is
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