Bulletin: August 19, 2011
Medicare Part B Secondary Payer Deductible Issues
Effective Friday, April 1, 2011, CMS implemented CR 7026 – Allowing the Common Working File (CWF) to accept both Medicare Secondary Payer (MSP) and Non-MSP Lines on MSP Claims and MSP Adjustment Claims. Medicare Part B claims processed after Friday, April 1, 2011, for which the beneficiary has a Medicare deductible remaining and Medicare is the secondary payer, are erroneously issuing payment despite the beneficiary’s deductible not being satisfied or despite the total Medicare Allowed Amount being applied towards the deductible.
The recovery of overpayments made during this time will be performed systematically. The recovery process has not yet been scheduled for implementation.
In addition to these overpayments, Physical Therapy and Occupational Therapy claims processed after Friday, April 1, 2011, where Medicare is the secondary payer and a deductible is not met are being held up by the system and are not being paid. CMS anticipates both of these issues to be resolved in November 2011.