memoranda 2006

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3/31/2006 12:00:00 AM


M e m o r a n d u m

TO:                  Clinic Directors

                        Finance Directors


FROM:            Deb Williams, Vice President,

                                    Reimbursement & Regulatory Compliance

DATE:             March 31, 2006

RE:                 Medicare Part A Billing

As you know, Medicare Fiscal Intermediaries in NYS take the position that Medicare does not cover long-term, maintenance therapy.  Although we were informed by NYS Medicaid that we only need to obtain one denial per consumer per year, we still must bill Medicare and obtain the one denial.  We have been trying for several years to find a way to bill Medicare simply to obtain a denial.  We have not been very successful.  Recently, we received clarification from a representative of Part A regarding how to bill for services that we know will be denied, but that are not statutorily excluded. 

We were told by Peggy Yankay, a Senior Professional Relations Representative for Empire Medicare Services in Syracuse (Part A), that for a service which is maintenance from the start (i.e., our long-term therapy services), we should use condition code 21 and submit it as a non-covered service.  This will provide us with the denial we need to then bill Medicaid.

We realize this information only pertains to those Affiliates that bill Medicare Part A.  Please disregard if you do not bill Part A. 

If you have any questions, please feel free to contact me.

cc:  Executive Directors

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