Practice Management Alert

The Centers for Medicare & Medicaid Services (CMS) recently identified a problem in which claims were not automatically crossing over to supplemental payers.

CMS suggested in a statement that providers who participate in Medicare Part B should resubmit any remittance advice issued between January 5, 2010 and February 12, 2010 that has two or more service lines for a beneficiary where the following conditions 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.

The problem: CMS is not able to forward these claims to the supplemental payers.

What you should do: Review your claims submitted during that period to see if any meet the above criteria. If so, you will need to balance bill the patient's supplemental payer.

CMS says that supplemental payers have been notified of the issue, and that any claims made after February 12 do not pose a problem.