| NHIC, Corp.DME MAC A ListServe | For Immediate Release |
| July 14, 2009 Claims Processing Change for Capped Rental Modifiers (KH, KI, and KJ)Over the years, NHIC, Corp. DME MAC A has continued to correct claims with the improper use of the KH, KI, and KJ modifiers on capped rental items and PEN pumps. For claims submitted with the inappropriate capped rental "K" modifier, NHIC has manually intervened to correctly append the appropriate "K" modifier to allow for proper processing. This notice is to advise that effective with claims received on or after September 18, 2009, NHIC will no longer provide these corrections and will reject claims that are not billed with the appropriate "K" modifier with ANSI reason code 182, remark code N56.When billing a capped rental item or a PEN Pump, the "KH" modifier shall only be used for the first month of billing. The "KI" modifier shall only be used for the second and third months of billing. The "KJ" modifier shall then be used for the remainder of the capped rental period (months 4-13), and the PEN pump rental period (months 4-15). All other applicable modifiers must also be included when billing. Please reference the link below for a complete list of modifiers: http://www.medicarenhic.com/dme/medical_review/mr_hcpcs/2009_hcpcs_modifiers.pdfAdditionally, if the capped rental item was previously provided to a Medicare beneficiary and a new rental period is now being requested, a narrative must be added that clearly explains why the item is being replaced to avoid unnecessary rejections. NHIC recommends that you use our Interactive Voice Response (IVR) system at 1-866-419-9458 to verify if equipment was previously provided. Effective with claims received on or after September 18, 2009, NHIC will begin rejecting claims with modifier "KH" when a previous initial capped rental month is on file and the claim is submitted without a narrative that clearly supports a new rental period. These claims will reject with ANSI reason code 182, remark code N56.If a rejected claim occurs due to either situation outlined above (the incorrect billing of the "K" modifier or missing narrative), the claim must be corrected with the proper information and re-submitted. This correction will not be handled through the re-openings process. NHIC strongly recommends suppliers check the IVR to ensure the first month's claim (KH modifier) was appropriately adjudicated prior to billing subsequent rental months (KI and KJ modifiers). |
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