Trailblazer Initiates Claims Adjustments

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  • June 1, 2009
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Trailblazer Health Enterprises, LLC posted on its Web site May 15 a notice of mass adjustments it needs to make to claims for 2009 inpatient (Part A) claims with Medicare Severity-DRG (MS-DRG) 956 Limb reattachment, hip & femur proc for multiple significant trauma paid under the special-pay method.

The 2009 Inpatient Prospective Payment System (IPPS) final rule designated MS-DRG 956 as a post-acute care DRG; however, it incorrectly remained on the list of special-pay, post-acute care transfer MS-DRGs within the 2009 IPPS Pricer.
As a result, 2009 claims that qualified as a transfer under MS-DRG 956 were paid under the special-pay method, resulting in improper overpayments.
Trailblazer will complete by Aug. 1 mass adjustments for claims that meet the following criteria:

  • Have a discharge date on or after Oct. 1, 2008
  • Were assigned MS-DRG 956
  • Were assigned a transfer Pricer Return Code 10

Trailblazer initiated this action in accordance with the Centers for Medicare & Medicaid Services (CMS) transmittal 492, change request (CR) 6483, issued May 8.

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