Medicare Claims

Medicare Claims From April 1, 2013 Will Be On Hold Till April 14, 2013

The Centers for Medicare & Medicaid Services (CMS) has identified technical issues with certain parts of the April 2013 quarterly systems release. For claims with dates of service or “through dates” on or after April 1, 2013, the issues affect (1) all home health final claims, (2) outpatient critical access hospital (CAH) and rural health clinic (RHC) claims where dollars have been applied to the beneficiary deductible, and (3) the remittance advice summary payment amount for Medicare Advantage inpatient prospective payment system (IPPS) claims with indirect medical education (IME).

Actual payments and the claim-level payment amounts on the remittance advice are correct for these Medicare Advantage IPPS IME claims. Final home health, outpatient CAH and RHC, and Medicare Advantage IPPS IME claims with dates of service or “through dates” prior to April 1, 2013, are unaffected. In addition, for claims pending with or received by the Medicare claims administration contractors on or after April 1, 2013, the issues affect (1) all claims for assistant-at-surgery services, and (2) all ambulatory surgical center claims.

As a result of these issues, CMS has instructed its Medicare claims administration contractors to hold all of these specific claim types until April 14, 2013, when system fixes are expected to be implemented. These claims will be released for processing on April 15, 2013. The claim hold should have minimal impact on provider cash flow because, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 for paper claims) after the date of receipt.

CMS regrets any inconvenience and is working to resolve these issues as quickly as possible.

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