Medical Billing Forum
Billing => Facility Billing => : solids19 March 15, 2019, 06:02:38 PM
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Specs:
Noridian MAC
Not a Mass Immunizer
Not a Roster Billing
Not RHC or FQHC facility
CPT/HCPCS: 90674 (Influenza)/G0008 (Administration)
Dx: Z23
TOB: 131
Condition code: A6
Medicare Denial RARC code: 45
Claims submitted individually via UB-04 w/TOB 131.
We are billing Medicare for immunization, example seasonal influenza. Got Medicare Remittance Advice denial code of RARC-45, charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Not clear what we are missing, any suggestions/ideas? Thanks in advance!
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I wasn't aware that facilities could bill for administration of influenza vaccine. Doesn't this have to be billed on a CMS 1500?
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I wasn't aware that facilities could bill for administration of influenza vaccine. Doesn't this have to be billed on a CMS 1500?
Hospital Billing. Providers do not own any of the vaccines.
CMS Medicare Learning Network (MLN)
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/qr_immun_bill.pdf (page 9) show various Facility Types and TOB.
Claims were reported as instructed with Revenue Codes:
0636 – vaccine
0771 – vaccine administration
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Well ya learn something new everyday!
Does the reason code 45 have a letter in front of it? I'm not finding any RARC code with just 45. Maybe an "M" or an "N"?
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Well ya learn something new everyday!
Does the reason code 45 have a letter in front of it? I'm not finding any RARC code with just 45. Maybe an "M" or an "N"?
It's CARC rather RARC.
https://med.noridianmedicare.com/web/jeb/topics/claim-submission/reason-code-guidance (Noridian Medicare)
http://www.x12.org/codes/claim-adjustment-reason-codes/ (Washington Publishing Company)
Ex) Billed Charges $15, Allowed $15, Contractual Adjust $15, Paid Amount $0. Reason/Remark Codes (CARC-45). Both vaccine & vaccine administration adjusted in the same manner.
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I can't find any information on that code other than contractual adjustment. Is there any other reason or remark codes on the eob?