NCMS Intervenes to Address Medicare Denials for New Patient Visits

This week NCMS averted a major disruption of payment for new Medicare patient office visits.

Numerous physician practices notified the NCMS about a surge in claims denials from Palmetto GBA for new patient assessments provided by physician assistants and nurse practitioners. NCMS traced the problem to a November 30, 2011 article on Palmetto’s website that stated “Palmetto GBA will monitor to ensure that CPT codes 99201-99205 are submitted by physicians only.”

NCMS found the new policy to be in conflict with Medicare rules for PAs and NPs who bill for new patient office visits under their own National Provider Identification number.  After direct discussions with NCMS, Palmetto GBA agreed to retract the article and remove the claims system edit that caused all the denials.

Most notably, Palmetto GBA also agreed to handle the affected claims in a mass adjustment, which should not require any additional action by the affected practices. 

This issue might not have been resolved quickly without the help of members who contacted the NCMS.  We thank our members for alerting us to this issue, and encourage you to continue contacting our Member Resource Center with problems involving payment for medical services.  The NCMS will continue to monitor this situation and provide updates.


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