February 2006 Newsletter

To “Q” You In

By: Quality Assurance

Elimination of the Use of Surrogate UPINs (OTH000) on Medicare Claims

Currently, physicians are allowed to bill for diagnostic, radiology, consultation services, and equipment with the use of surrogate UPINs, which were intended to be used during an interim period when a UPIN has been requested, but not yet received. Last year, a Medicare Program Safeguard contractor identified an excessive number of claims that were submitted with the surrogate UPIN, when in many cases, UPINs were assigned.

To address this issue, CMS announced in CR4177 that it will no longer accept the Surrogate UPIN "OTH000" to identify the ordering or referring physicians on claims submitted, effective for dates of service (DOS) April 1, 2006, and later.  Quadax edits have been updated, and any claims submitted using OTH000 and a DOS of April 1, 2006, or later will be rejected.

New Health Professional Shortage Area (HPSA) Modifier

The two HCPCS modifiers (QB and QU), currently used on claims qualifying for the HPSA bonus payments, were deleted on January 1, 2006. One new modifier (AQ) has been created for HPSA claims with dates of service January 1, 2006, and later. Claims with DOS prior to January 1, 2006, must continue to use the current HCPCS modifiers QB and QU.