Prescribed Drugs Provider Manual - Iowa Department of Human ...

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IowaDepartmentof HumanServicesProvider and ChapterPrescribed DrugsChapter III. Provider-Specific PoliciesPage121DateAugust 1, 2013a. Documentation of the ServiceThe billing provider must document in the patient’s record the:♦ Interpreter’s name or company,♦ Date and time of the interpretation,♦ Service duration (time in and time out), and♦ The cost of providing the service.b. QualificationsIt is the responsibility of the billing provider to determine theinterpreter’s competency. Sign language interpreters should be licensedpursuant to Iowa Administrative Code 645 Chapter 361. Oralinterpreters should be guided by the standards developed by theNational Council on Interpreting in Health Care (www.ncihc.org)The following are instructions for billing interpretive services when thatservice is provided by an outside commercial translation service.♦ Bill code T1013 on the professional CMS-1500 claim form:• For telephonic interpretive services use modifier “UC” to indicatethat the payment should be made at $1.70 per minute.• The lack of the UC modifier will indicate that the charge is beingmade for the 15 minute face-to-face unit.♦ Enter the number of minutes actually used for the provision of theservice.♦ Special note: Because the same code is being used but a conditionalmodifier may be necessary, any claim where the UC modifier is NOTused and the units exceed 24 will be paid at 24 units.
IowaDepartmentof HumanServicesProvider and ChapterPrescribed DrugsChapter III. Provider-Specific PoliciesPage122DateAugust 1, 2013G. REMITTANCE ADVICE AND FIELD DESCRIPTIONS1. Remittance Advice ExplanationTo simplify your accounts receivable reconciliation and posting functions, youwill receive a comprehensive Remittance Advice with each Medicaid payment.The Remittance Advice is also available on magnetic computer tape forautomated account receivable posting. To view a sample of this form on line,click here.The Remittance Advice is separated into categories indicating the status ofthose claims listed below. Categories of the Remittance Advice include paidclaims and denied claims:♦ Paid indicates all processed claims, credits and adjustments for whichthere is full or partial reimbursement.♦ Denied represents all processed claims for which no reimbursement ismade.Note that claim credits or recoupments (reversed) appear as regular claimswith the exception that the transaction control number contains a “1” in thetwelfth position and reimbursement appears as a negative amount.An adjustment to a previously paid claim produces two transactions on theRemittance Advice. The first appears as a credit to negate the claim; thesecond is the replacement or adjusted claim, containing a “2” in the twelfthposition of the transaction control number.If the total of the credit amounts exceeds that of reimbursement made, theresulting difference (amount of credit less the amount of reimbursement) iscarried forward and no check is issued. Subsequent reimbursement will beapplied to the credit balance, as well, until the credit balance is exhausted.A detailed field-by-field description of each informational line follows. It isimportant to study these examples to gain a thorough understanding of eachelement as each Remittance Advice contains important information aboutclaims and expected reimbursement.Regardless of one’s understanding of the Remittance Advice, it is sometimesnecessary to contact IME Provider Services with questions. When doing so,keep the Remittance Advice handy and refer to the transaction controlnumber of the particular claim. This will result in timely, accurateinformation about the claim in question.
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