CMS Announces Problems with Medicare Claims Crossover to Secondary Payers
On Feb. 17, 2010, CMS has identified a problem where claims were not automatically crossing over to secondary payers even though the provider remittance advice indicated otherwise. This problem began January 5, 2010.
Action is required on behalf of Part B professional providers where a remittance advice with an issue date between January 5, 2010, and February 12, 2010, has two or more service lines for a beneficiary where both of the following apply:
- One service line is 100 percent reimbursable (i.e., the approved amount and amount to be paid are equal,) AND
- One service line where part of or the entire Medicare approved amount is applied to the Part B deductible and/or carries co-insurance amounts.
CMS is not able to forward these beneficiary claims to supplemental payers even though the remittance advice may indicate otherwise. Providers will need to identify these claims by reviewing their remittance advice with an issue date between January 5, 2010, and February 12, 2010, that contain the criteria noted above. Once identified, providers will need to take action to balance bill the beneficiary’s supplemental payer. As of February 12, 2010, this system problem was fixed and all claims are crossing over to supplemental payers as indicated on the provider remittance advice.
CMS has already notified supplemental payers of these issues. This information courtsy os the ASA Washington office.
CMS Delays Implementation of PECOS Enrollment Policy
The Centers for Medicare & Medicaid Services (CMS) will delay implementation of the second phase of modifications to the Provider Enrollment, Chain, and Ownership System (PECOS) regarding ordering/referring providers from April 5, 2010 until Jan. 3, 2011. Providers who enrolled in Medicare prior to 2003 but have not completed the revalidation process are not included in the PECOS system. CMS had plans to reject claims associated with these providers starting April 5, 2010. CMS’ plans have been revised to include the following activity pior to the new Jan. 3, 2011 deadline:
- Continue to place warnings on claims in which the ordering/referring is not enrolled in PECOS;
- Update the Medicare Ordering/Referring File;
- Remind providers who enrolled in Medicare prior to 2003 but have not completed the revalidation process to submit a new enrollment application either in the paper form or by using Internet-based PECOS.
