Bulletin: February 18, 2010
Medicare Crossover Claims Update
The Centers for Medicare & Medicaid Services (CMS) has identified a problem beginning January 5, 2010, where claims were not automatically crossing over to supplemental payers even though the provider remittance advice indicated otherwise.
No action is required of Part A institutional providers. CMS successfully implemented a system fix, and all claims are transmitting properly to supplemental payers. Please allow until March 1, 2010, for supplemental payers to receive and process these claims before attempting to balance bill them for any remaining balances.
Part B professional providers need to take action for remittance advice issued between January 5, 2010, and February 12, 2010, if the advice has two or more service lines for a beneficiary where:
- One service line is 100 percent reimbursable and
- One service line has at least part of the Medicare approved amount applied to the Part B deductible and/or carries co-insurance amounts.
Part B providers need to review remittance advice from January 5 to February 12, 2010, to identify these claims and balance bill the supplemental payer. As of February 12, the system problem was fixed, and all claims are transmitting properly to supplemental payers.