CMS Identifies Supplemental Payer Crossover Error

CMS recently identified a problem that requires immediate action on the part of Medicare Part B providers. Apparently, claims were not automatically crossing over to supplemental payers even though provider remittance advice indicated otherwise.

Providers should review their remittance advice with an issue date between Jan. 5 and Feb. 12. Look for remittance advice that has two or more service lines for a beneficiary where both of the following criteria apply:

One service line is 100 percent reimbursable (i.e., the approved amount and the amount to be paid are equal); and
One service line where part or the entire Medicare approved amount is applied to the part B deductible and/or carrier coinsurance amount.
Once identified, providers should take action to balance bill the beneficiary’s supplemental payer. According to CMS, this problem was fixed as of Feb. 12, 2010.