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 and impacted 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.

From the Medical Group Management Association. For membership information, go to www.mgma.com.