CMS & Palmetto/J1MAC News

The following information has been received by ANCO.


****CMS NEWS****
The Centers for Medicare & Medicaid Services (CMS) has identified a problem where claims were not automatically crossing over to supplemental payers even though the provider remittance advice indicated otherwise. This problem began January 5, 2010. Part A institutional claims and Part B professional claims, with the exception of supplier claims processed by Durable Medical Equipment Medicare Administrative Contractors (DME MACs), were impacted by this problem. Claims processed by DME MACs were not impacted.

Part A Institutional Claims

No action is required by Part A institutional providers. As of February 2, 2010, CMS successfully implemented a systems fix to ensure that all Part A institutional claims are now crossing over to supplemental payers as indicated on the remittance advice received by providers. As part of the fix, CMS’ Medicare contractors were able to identify claims processed between January 5 and February 1, 2010, where the provider remittance advice indicated that the affected claims were crossed over to various supplemental payers but were not. On February 2, 2010, the affected Medicare contractors began to send the affected claims to the Coordination of Benefits Contractor (COBC) to be crossed over to supplemental payers. This effort is now largely completed. Please allow until March 1, 2010, for supplemental payers to receive and process these claims before attempting to balance bill them for any remaining balances after Medicare.

Part B Professional Claims

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.

The CMS has already notified supplemental payers of these issues. We regret any inconvenience you may experience related to this Medicare claim supplemental payer crossover problem.


****PALMETTO/J1MAC NEWS****
Claims Processed with Remittance Advice Remark Code N265
Share with your staff - In compliance with the final implementation phase
of Change Request (CR) 6417, effective April 5, 2010, claims submitted with
the RA remark code N265 will be rejected. To help providers avoid claim
rejections and reimbursement delays, Palmetto GBA recommends immediate
provider actions to correct two specific billing errors before April 5.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82PLZX7134?opendocument


Healthcare Provider Taxonomy Codes (HPTC): April 1, 2010 Update
CMS has released the summary of changes reflected in the Health Care
Provider Taxonomy Code (HPTC) list. Medicare carriers and DME MACs will
update their HPTC tables with this new version effective on April 1, 2010.
Please review the information and stay current on all HIPAA requirements to
assure timely processing of your claims.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7VBKAL6460?opendocument


ACT Minutes: New Year, Fresh Start - January 26, 2010
The minutes of the J1 Part B ACT call on January 26, 2010, is now available
on our Web site.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82PUH27852?opendocument


Instructions on How to Process Negative Claim Adjustment Reason Code (CARC)
Adjustment Amounts when Certain CARCs Appear on Medicare Secondary Payer
Claims
This J1 A/B MAC MLN Matter article (CR6736) provides Medicare contractors
with processing instructions for claim adjustment reason code (CARC)
adjustment amounts that are negative when certain CARCs appear on incoming
Medicare Secondary Payer (MSP) claims. Medicare contractors will
automatically reprocess any MSP claims retroactive to July 5, 2009, and
remove the positive Claim Adjustment Segment (CAS) CARC adjustment from the
primary payer payment amount where a CARC adjustment was added to the
primary payer payment amount when the same CAS CARC adjustment was received
as a negative adjustment. Providers are encouraged to review the
information and share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82QPN67656?opendocument


Medicare Claims Crossover to Supplemental Payer Problem
The Centers for Medicare & Medicaid Services (CMS) has identified a problem
where claims were not automatically crossing over to supplemental payers
even though the provider remittance advice indicated otherwise. This
problem began January 5, 2010. No action is required by Part A
institutional providers. Action is required on behalf of Part B
professional providers for certain claims. The affected Part B claims are
associated with a remittance advice dated between January 5, 2010, and
February 12, 2010, that contain two or more service lines for a beneficiary
and that meet both of the following criteria: one line is 100 percent
reimburseable, and at least some money was applied to the deductible.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82QRXL0601?opendocument


Palmetto GBA Online Learning Instructions
Palmetto GBA has revised the Online Learning Center user instructions to
reflect the recent update in the Webinar vendor Centra One system.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XWSSK3475?opendocument


Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 16.1,
effective April 1, 2010
This J1 Part B MLN Matters article (CR6819) provides a reminder for
physicians to take note of the quarterly updates to Correct Coding
Initiative (CCI) edits. The last quarterly release of the edit module was
issued in January 2010. The National Correct Coding Initiative (CCI) was
developed to promote national correct coding methodologies and to control
improper coding that leads to inappropriate payment in Part B claims.
Providers are encouraged to review the information and share with their
staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82QPS64434?opendocument


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