Quick ContactPhone Support: 1-800-876-0243 firstname.lastname@example.org 2916 E. Central Wichita, KS 67214
TEL: 316-268-5690 or 800-876-0243
Hours of Operation:
Monday - Friday, 8:30 a.m. – 4:30 p.m.
Our billing department is dedicated to answering all types of client, patient and third-party inquiries. The phone numbers listed above will provide you or your patients access to trained customer service representatives. Please call at any time during normal business hours.
The Centers for Medicare and Medicaid Services (CMS) is responsible for ensuring that services being paid for by the Medicare program are medically necessary. CMS has created national edits called National Coverage Determinations (NCDs), which require documentation of medical necessity before a claim may be paid. In addition, local carriers maintain a list of Local Medical Review Policies (LMRPs) that also require documentation of medical necessity.
Local Medicare carriers have the authority to deny claims when the diagnosis code(s) provided for a test does not substantiate medical necessity. If a physician does not submit a covered ICD-9 code for an NCD or LMRP, AMS will contact the physician’s office to request a diagnosis indicating medical necessity. If a covered diagnosis code is not available, AMS will expect a completed Advanced Beneficiary Notice to be attached to the requisition in order to bill the patient. Directions for completing the ABN are on the requisition. If an ABN has not been completed, AMS will bill the client.
Tests that are subject to NCDs and LMRPs are printed in red on the requsitions. The Medicare carrier may approve additional LMRPs for other laboratory tests at any time. A complete listing of all NCDs and LMRPs along with covered diagnosis codes can be found at www.cms.hhs.gov/coverage.
CPT codes listed in this Service Guide are provided only as guidance to assist you in billing. CPT codes listed reflect our interpretation of CPT coding requirements and are subject to change at any time. It is the client’s responsibility to verify the accuracy of the codes. If you have questions, please refer to the Current Procedural Terminology (CPT) manual published by the American Medical Association.