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IMA Admin Update
APG Billing - Update 4
February 9, 2012
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IMA Admin UpdateHere is some more important information we want to share with you regarding APG billing.
Medicaid "Zero Fill"
We have just learned important new information regarding the common practice of "zero filling" the payments from previous payers when it is known that they will not pay for the services provided.
"Zero filling" is done at the claim level, and therefore if a claim contains multiple services, it can only be "zero filled" if ALL of the services are that way. A single claim can not contain one service that was paid by a previous payer and another that was a "zero fill". In that case both claims would need to be billed and remitted from the previous payer. This was never an issue prior to APG billing because claims only contained a single service.
Here is a common example where this might be a problem. Lets take a case when a client has Medicare/Medicaid and was seen after hours for a regular service. The regular service will be billed to Medicare, but typically the after hours enhancement would zero fill Medicare and just bill to Medicaid. Under APG billing this would not be allowed. The 99051 after hours service line would need to be billed to Medicare.
If anyone has information to the contrary please let us know.
APG Changes and Enhancements A few additional APG related changes and enhancements have been released this week. They will be on your systems the next time an update is installed. - IMA Grouper exception codes: We have added two exception messages in the IMA grouper. One for claims over 90 days old that are missing a 90 reason code and another for voids/adjustments that are missing a CRN number.
- APG Billing M errors: We have added a number of new APG M errors. These are validations on the adjustments records from previous payers being balanced (parallel to M75 in service billing) and validations for claims with multiple services where some are paid and some are excluded from previous payers (see Zero fill note above).
Training The two web based training sessions in the past week were very well attended and we hope the information covered was useful. There have been a few requests for repeats. Please let us know if your agency is interested and we can try to accommodate you.
A compilation of the notes from these trainings can be downloaded by clicking here.
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