Changes In Bypass Payment Edits For Kidney Donor Transplant

The MACs to implement logic that ensures they bypass payment window edits (3-days and 1-day) when processing claims for donor post-kidney transplant complications services. MACs will hold certain claims, as noted below, until Medicare’s Common Working File (CWF) system edits these claims correctly.

3-Day Payment Window Edits:

• 7109: Outpatient Diagnostic Service against Inpatient in history
• 7113: Inpatient against Outpatient Diagnostic Service in history
• 7114: Outpatient Therapeutic Service against Inpatient in history
• 7115: Inpatient against Outpatient Therapeutic Service

1-Day Payment Window Edits:

• 7119: Outpatient Diagnostic Services against Inpatient in history
• 7120: Inpatient against Outpatient Diagnostic Services in history
• 7121: Outpatient Therapeutic Services against Inpatient in history
• 7122: Inpatient against Outpatient Therapeutic Services in history

Reference:https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM11312.pdf