New Policy and Refinements on Billing Noncovered Charges to Fiscal Intermediaries (FIs)
Basic comprehensive instructions on billing noncovered charges to FIs are found in Chapter 1, Section 60 of Medicare’s On-line Publication 100-04 on Claims Processing. Since publication of the summary instructions, CMS has become aware of a few required refinements and new needs: (1) Allowing totally noncovered provider-liable outpatient claims without either condition codes 20 or 21, (2) providing additional guidance on billing bundled services related to an ABN, with specific examples for rural health clinics (RHCs), federally qualified health clinics (FQHCs) and laboratory panel tests billed on institutional claims, (3) Bypassing of some edits related to noncovered ambulance line items using the –QM or –QN modifiers , and (4) Other updates to Web site addresses, conforming text and comparable administrative changes. The attached revision for this publication provides a needed link to 100-04 to clarify existing language on liability for collection of co-insurance and
deductible.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: October 22, 2004
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