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Provider Update Newsletter
January 2007, Volume 171
 

All Providers

Do You Have Your NPI?
Medical and other Record Content Requirements
Department of Human Services Holiday Observations for 2007
 

Physician Providers

Reimbursement for Procedure Code A9500 and Q Codes

Do You Have Your NPI?

Rhode Island Medical Assistance is starting to collect NPI numbers from our providers. The following is required for Medical Assistance. If you received a hard copy letter from the enumerator you can fax a copy to 401-467-9581, Attn: Enrollment. If you received your NPI number via email you can forward that email to us by clicking here. Please note that either way you choose to send it we will need the following information.

1. Your NPI Number

2. The Taxonomy code you were assigned or placed on your NPI application. This will decrease the chances of your NPI cross walking to the incorrect legacy number and delaying or denying payment

3. All current Medical Assistance provider numbers. Including your attending numbers within a group

4. Your Billing Name and telephone number

For more information on NPI, click here.

Important NOTICE: If your office is billing as a group, the group or organization must obtain an NPI for the practice as well as the individuals with in the group.

NPI Tip

When applying for your NPI, CMS urges you to include your legacy identifiers, not only for Medicare but for all payers. If reporting a Medicaid number, include the associated State name. This information is critical for payers in the development of crosswalks to pay you. You are able to apply for your NPI in one of three ways:

• You may apply through an easy web-based application process, which began May 23, 2005 by clicking here.

• You may prepare a paper application and send it to the entity that will be assigning the NPI (the Enumerator) on behalf of the Secretary, which began July 1, 2005. A copy of the application, including the Enumerator’s mailing address, is available by clicking here. You may also call the Enumerator for a copy. The phone number is 1-800-465-3203 or TTY 1-800-692-2326.

• With your permission, an organization may submit your application in an electronic file. This could mean that a professional association or perhaps a health care provider who is your employer could submit an electronic file containing your information and the information of other health care providers. This process has been available since the fall of 2005.

Medical and Other Record Content Requirements

Providers are required to keep medical, dental, case or business records to fully document the services provided and payments received under the Medical Assistance Program. At a minimum, providers’ medical records should contain, but not be limited to:

• recipient identifiers

• the individual(s) providing the service(s)

• credentials of the professional(s) providing service(s)

• date(s) of service

• history of present illness

• current physical exam

• laboratory studies (EEG, EKG, X-Rays)

• diagnosis of what's wrong

• plan of action

• record of treatment provided on the date of service to support the claim

Providers must furnish these records for inspection, if requested, by appropriate State or Federal agencies.

Medical and other records must be retained for authorized inspection and audit purposes for a period of five (5) calendar years after the calendar year in which the service was provided. However, providers are advised that the statute of limitations for the Medical Assistance Fraud Control Act is ten (10) years. The Department of Human Services (DHS) policy manual requires the retention of records for a shorter period. See this information on the DHS website by clicking here.  This does not supersede the statutory requirements of the Act.
 

Department of Human Services Holiday Observations for 2007

The Department of Human Services will be closed on the following days:

Date	Holiday
Monday, January 1st	New Years Day
Monday January 15th	Martin Luther King Day
Monday, May 28th	Memorial Day
Wednesday, July 4th	Independence Day
Monday, August 13th	Victory Day
Monday, September 3rd	Labor Day
Monday, October 8th	Columbus Day
Monday, November 12th	Veteran’s Day
Thursday, November 22nd	Thanksgiving Day
Tuesday, December 25th	Christmas Day

 

Reimbursement for Procedure Code A9500 and Q Codes

Reimbursement for Procedure Code A9500

Effective January 1, 2005 procedure code A9500-Supply of Radiopharmaceutical Diagnostic Imaging Agent, Technetium TC 99M Sestamibi, per dose; physicians can now bill for Medical Assistance.

The code will be active from January 1, 2005. For further assistance or questions regarding policy and billing procedures, please contact your provider representative, Ashley Cunningham by calling 401-784-3832 or email Ashley by clicking here.

Reimbursement for Q Codes - Low Osmolar Contrast Materials:

The following is a list of codes that are effective beginning January 1, 2006. Service limits are billable up to 100 units per date of service.
 

Procedure Code	Description	Reimbursement
Q9945	LOW OSMOLAR CONTRAST MATERIAL, UP TO 149 MG/ML IODINE CONCENTRATION, PER ML	$    .37
Q9946	LOW OSMOLAR CONTRAST MATERIAL, 150-199 MG/ML IODINE CONCENTRATION, PER ML	$  1.84
Q9947	LOW OSMOLAR CONTRAST MATERIAL, 200-249 MG/ML IODINE CONCENTRATION, PER ML	$  1.42
Q9948	LOW OSMOLAR CONTRAST MATERIAL, 250-299 MG/ML IODINE CONCENTRATION, PER ML	$    .26
Q9949	LOW OSMOLAR CONTRAST MATERIAL, 300-349 MG/ML IODINE CONCENTRATION, PER ML	$    .34
Q9950	LOW OSMOLAR CONTRAST MATERIAL, 300-349 MG/ML IODINE CONCENTRATION, PER ML	$    .21
Q9952	INJECTION, GADOLINIUM-BASED MAGNETIC RESONANCE CONTRAST AGENT, PER ML	$  2.89
Q9953	INJECTION, IRON BASED MAGNETIC RESONANCE CONTRAST AGENT, PER ML	$30.41
Q9954	ORAL MAGNETIC RESONANCE CONTRAST AGENT, PER ML	$    .09
Q9956	INJECTION, OCTAFLUOROPROPANE MICROSPHERES, PER ML	$49.61
Q9957	INJECTION, PERFLUTREN LIPID MICROSHPERES, PER ML	$61.72