DME MAC D Gives Instruction on Resubmitting Oxygen Claims

FARGO, N.D.–Noridian Administrative has issued instructions for
resubmission of oxygen claims “for subsequent months if
[providers] have received payment for the initial replacement month
(the claim with the RA or RP modifier).”
 
According to an update from the Jurisdiction D DME MAC, some
providers have received non-covered denials with the N370 message
(billing exceeds the rental months covered/approved by the payer).
This happened “because the claim with the RA or RP modifier
had not yet been worked by our claims staff and the new CMN for the
replacement equipment was not yet loaded into the claims processing
system,” NAS said.
 
Claims that should be resubmitted are claims with dates of service
Jan. 17 through March 31, 2009.
 
The MAC’s message also noted providers may have been
previously instructed that these subsequent rental claims would be
“mass adjusted” by NAS and no further action would be
needed. “Our plan was to do these mass adjustments but after
further review we have determined that the most expeditious way to
handle these claim denials is to ask suppliers to resubmit,”
the update said, adding these reminders about replacement oxygen
claims:
 
—Only the initial oxygen claim requires a modifier RP, prior
to Jan. 1, 2009, or modifier RA, effective Jan. 1, 2009, and after,
when replacing oxygen equipment.
 
—Subsequent oxygen rental claims, those billed after the
initial month of replacement, should not include the RP or RA
modifier.
 
Read the complete notice on the NAS Web site.