Paper Claims Returned for Item 33b
National Government Services, a durable medical equipment Medicare administrative contractor (DME MAC), is returning paper claims when providers fill in item 33b. The DME MAC for Jurisdiction B reports an increase in the number of paper claims returned to suppliers because item 33b of the CMS-1500 paper claim form contained either the Provider Transaction Access Number (PTAN) or National Provider Identifier (NPI). As of May 23, 2008, when submitting paper claims, suppliers are instructed to include the NPI in item 33a and to leave item 33b blank. When information is reported in item 33b, the paper claim will be returned to the supplier. The supplier must correct the claim and mail it back to the contractor.
The Centers for Medicare & Medicaid Services (CMS) recommends practices begin submitting electronically to avoid such issues with paper claims—which cause a delay in processing time—and to save time and money. The payment floor for an electronic claim is 14 days, or 29 days for paper claims. If you submit a paper claim incorrectly and it is returned, the payment floor does not start until the paper claim is accepted by National Government Services. This could possibly add several weeks to the 29 day payment floor.
Check with your software vendor to determine if you can use your current system to move into the electronic environment. If you do not have software available, consider using PC-ACE Pro32. This is a free software program available for the submission of your Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claims. The steps on how to become an electronic submitter are available in chapter 13 of the Jurisdiction B DME MAC Supplier Manual.
If you decide to continue billing paper claims, be sure to leave item 33b on the paper form blank and review chapter 12 of the manual for the “CMS-1500 Claim Form Field Descriptions and Instructions.”