CMS Alerts Physicians to Billing Glitch

Affected Claims Processed Between Jan. 5 and Feb. 12

March 01, 2010 12:05 am News Staff

Physicians who are participating Medicare providers should be aware of a glitch in CMS' system that occurred when some claims did not cross over to supplemental payers automatically, although the provider remittance advice indicated otherwise.

According to CMS, physicians should carefully examine Part B professional claims processed between Jan. 5 and Feb. 12. Physicians need to take action if the remittance advice was for two or more professional services and if both of the following conditions apply:

  • one service, such as an influenza immunization, was 100 percent reimbursable; and
  • one service was applied, either partially or in full, to the Part B deductible and/or carried coinsurance amounts.

Physicians with claims that fall within those parameters are responsible for billing the secondary insurer or, as CMS describes the process, "balance bill" the beneficiary's supplemental payer. Normally, that process would happen automatically.

CMS says that the problem was fixed as of Feb. 12, and, since that date, all claims are crossing over to supplemental payers as indicated on the provider remittance advice.

In addition, CMS has notified supplemental payers of the problem.


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