Part B Insider (Multispecialty) Coding Alert

Published on Sat Apr 03, 2010 PDF

Plus: New analysis offers tips on migrating your ICD-9 system over to an ICD-10 based strategy.

Earlier this month, President Obama helped you avert a 21 percent pay cut by signing the "Continuing Extension Act of 2010" -- but one MAC let several claims slip through the system using the discounted payment formula, and the payer is in the process of correcting its error.

Just before the president signed the law on April 15, MACs had been holding all claims for dates of service between April 1 and April 14. Even though the pay freeze was retroactive to April 1, some practices worried that their MACs might process claims using the 21 percent reduced fee during the period on April 15 after the claims hold expired but before the president signed the law.

In one case, those fears may have been warranted.

According to an April 26 notification from Highmark Medicare Services (a Part B payer in five states), several claims for dates of service on or after April 1 and received between April 1 and April 7 "potentially paid at the incorrect -21 percent reduced fee schedule."

Highmark indicated that it had "identified the universe of claims impacted by the use of the incorrect fee schedule," and made a mass adjustment. "Our goal is to have initiated 95 percent of all adjustment claims by Wednesday, May 5th," Highmark indicated, promising to provide additional updates as the adjustments are made.

For more on this issue, visit www.highmarkmedicareservices.com.