Erythropoiesis Stimulating Agents - Incorrect Denials

Attention Members:
The NYSSMOH Board of Directors has contacted the Medical Director of National Government Services (Medicare) regarding the issue of incorrect denials for Erythropoiesis (see below) beginning November 2009. We have been advised that this issue will be corrected by Friday, December 11, 2009. We are also told that no action is needed by the provider and that Medicare will reprocess all claims that have denied incorrectly.

Please contact NYSSMOH Administrator Florence Madonia (845-986-3295 or fmbilling@yahoo.com ) if you continue to received denials after Friday, December 11th.

Thank you,
NYSSMOH Board of Directors

Attention Part B Medicare providers who bill Erythropoiesis Stimulating Agents to National Government Services:

National Government Services has identified an issue with edit 638A based on the Local Coverage Determination Erythropoiesis Stimulating Agents L25211. It has been identified that claims are denying inappropriately with reason codes 029 or 481, These are non-covered services because this is not deemed a 'medical necessity' by the payer.We are working to correct this issue, and expect it to be resolved by mid-December 2009. All claims that have been incorrectly denied will be adjusted by National Government Services. Providers do not need to take any action at this time.Thank you for visiting the National Government Services Web site!National Government Services encourages all Web site users to provide feedback regarding ways to improve our Web site. The ForeSee Results (pop-up) survey is an easy mechanism for providers to use to let us know how we can best serve you. Your comments play a large role in the enhancements that are made to the National Government Services Web site.National Government Services, Inc.Corporate Communications