Recently, there have been additional changes pertaining to the Grandfather Exemption. It seems that CMS now wants the provider to be set up as a specialty code 69 provider. This means that if you are billing under the grandfather clause then your specialty code should be listed as 69. Some providers are going back to CMS and attaching this specialty code to their current NPI number.
The reasoning behind this new change may be that CMS currently has no database of who is grandfathered and who is not. Therefore, if they require you to be a specialty code 69, then they can use this designation as a way to track providers.
As an interesting twist in this story, we are already starting to see some commercial providers denying claims under this rule. Want to know more? Call me for further information. Mich Raich, Vachette Pathology at 517-486-4262.
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