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San Francisco Marin Medical Society Blog

Noridian Denials of E&M Services

The Centers for Medicare and Medicaid Services (CMS) experienced some editing issues with new patient E&M codes which resulted in incorrect denials by the Medicare contractors.

These problems started in October 2013, and some of the editing was corrected in late January 2014. Noridian began making mass adjustments and correcting claims subjected to overpayment recovery. However, some problems continued into July. Unfortunately, as Noridian began the process of implementing corrections, they inadvertently subjected established patient E&M codes to incorrect editing, resulting in incorrect denial of codes 99211- 99215.

Noridian has corrected the editing for both the new patient codes and the established patient codes, and claims received by Noridian on and after July 16, 2014 should be processing correctly. Noridian is beginning the process of mass adjustments. Due to the number of claims involved (300,000 claims back to October of 2013), this process could take a month or so to complete. They are asking that physicians not resubmit the claims.

Click here to view the notice on this issue that reflects the established patient E&M problem and correction

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