Medicare Compliance & Reimbursement

How to get reimbursement for a paper claim that a contractor has denied.

Physicians, suppliers and providers requesting reimbursement from Medicare secondary payers have two new changes to prepare for. The Centers for Medicare & Medicaid Services announced changes to the Administrative Simplification Compliance Act Feb. 2 in a Medlearn Matters article. The resulting changes will go into effect on July 1:

1. To comply fully with the Health Insurance Portability and Accountability Act's regulations, Medicare will allow MSPs to reject inbound claims if the primary payer's payments and adjustments don't match the providers' bill amounts at the line level, and if the claim fails to include reason codes that identify relevant adjustments.

2. If Medicare contractors deny providers' paper claims based on the ASCA electronic claims provision, the provider may resubmit the paper claim within 91 days of its ASCA enforcement letter. But the claim's resubmission must include appropriate documentation that proves it meets submission criteria for paper claims.

To view the full Medlearn Matters article, go to www.cms.hhs.gov/MedlearnMattersArticles/downloads/mm4261.pdf.