REVISION to 9/16/24 Alert: Payment Policy Update to Code Editing Overview

Date: 10/07/24

This is a revision to the provider alert posted on September 16, 2024.

Centene Policy CC.PP.011 is an overview of our code editing process and will not specifically call out code editing changes like ambulance place of service and duplicate rev code recovery. Please see below specifics on these two CMS changes.

Ambulance Place of Service:

CMS guidelines state that ambulance services billed with place of service are incorrect, other than 41 (Land) or 42 (Air/Water). CMS’s discovery of paid ambulance claims with incorrect place of service could result in Civil Monetary Penalties (CMP). See Centers for Medicare & Medicaid Services [Chapter 26 – Completing and Processing, Section 10.5 – Place of Service Codes (POS) and Definitions, page 21].

Duplicate Rev Code Recovery:

Claims where the same service bills multiple times using the same revenue code, goes against CMS’s coding guidelines. Providers must ensure that each service charge has a distinct revenue code to prevent billing errors and potential audits. See Centers for Medicare & Medicaid Services (Chapter 1 – Suspect Duplicates, Subsection 120.3, pages 261 and 263).

For questions or concerns, contact your provider relations specialist in your area or call Provider Services at
1-833-404-1061, Monday – Friday 7:30 a.m. to 6 p.m. CT.

Thank you for your partnership in serving Iowa Total Care members.