• CMS Announces Problem with Claims Crossover to Supplemental Payers
  • March 2, 2010 | Author: Adam Laughton
  • Law Firm: King & Spalding LLP - Houston Office
  • On February 16, 2010, the Centers for Medicare and Medicaid Services (CMS) notified all Medicare providers that a computer error had caused certain claims to fail to crossover to supplemental payers. Providers were also notified that the provider remittance advice corresponding to these claims may have erroneously indicated that the claims had crossed over. The error affected Medicare Part A institutional claims processed between January 5, 2010 and February 1, 2010 and Medicare Part B professional claims between January 5, 2010 and February 12, 2010. Supplier claims processed by Durable Medical Equipment Medicare Administrative Contractors were unaffected.

    Providers filing Part A institutional claims were advised by CMS that no further action on their part would be necessary. Upon noticing the error, CMS reportedly implemented a fix and identified affected claims, which were then submitted to the Coordination of Benefits Contractor for proper submission to supplemental payers. Part A providers were advised to wait until after March 1, 2010 before attempting to bill such payers for amounts not reimbursed by Medicare.

    Providers filing Part B professional claims were advised that action would be required for them to identify certain claims processed during the affected dates by reviewing the remittance advice, after which they were instructed to balance bill the supplemental payer for amounts not reimbursed by Medicare. According to CMS, affected claims contain two or more service lines, one of which is 100% reimbursable, and another in which part or all of the Medicare approved amount was applied to the Part B deductible or co-insurance.