New remittance advice codes for PQRS claims-based reporting

Thursday, July 31, 2014 10:11 AM

Are you a PQRS eligible professional participating in claims-based reporting this year? Effective July 1, 2014, you will have to use the updated Remittance Advice Remark Codes (RARCs) for PQRS claims-based reporting that went into effect on April 1, 2014. CMS has released a new FAQ with information about the updated codes.

What are the new codes and what do they mean?

• Eligible professionals who bill on a $0.00 Quality-Data Code (QDC) line item will receive the N620 code, which replaces the current N365 code. Also, eligible professionals who bill on a $0.01 QDC line item will receive the CO 246 N572 code.
• The new RARC code N620 will be your indication that the PQRS codes were received into the CMS National Claims History (NCH) database.
• The new RARC N572 with the Claim Adjustment Reason Code 246 (with Group Code CO or PR) indicates that the procedure is not payable unless non-payable reporting codes and appropriate modifiers are submitted.

Remember: The new codes were effective on July 1, 2014. The old codes will be deactivated on the same date.

The above information was taken from the CMS MLN Weekly Provider eNews. You can sign up to receive this newsletter directly here.