The Centers for Medicare & Medicaid Services (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.

9 Responses to “CMS Identifies Supplemental Payer Crossover Error”

1. Joyce McKay-Merriman Says:
   March 3rd, 2010 at 9:19 pm

   I know the claims are not crossing over. I have to print claims and copy EOMBs and mail for secondary payers. It is a hastle. It is still not fixed as of March 3.

2. Susan Gabbard Says:
   March 4th, 2010 at 5:50 am

   Did this effect all Medicare carriers or just some, was Palmetto GBA effected?

3. Becky Hughes Says:
   March 4th, 2010 at 6:09 am

   You have to wonder if it is worth the cost of having to drop to paper claims and copy eobs to collect the 20% of many low paying procedures. This is at least the second time in the last year this has happened to providers. Surely the medicare carriers could find a solution to their mistakes.

4. jo burt Says:
   March 4th, 2010 at 7:29 am

   this is one the reasons why alot of your physicians offices are leaving the filing of secondary claims to the patients to file themselves and collecting their 20% up front at time of service. Our office still files the secondary as a courtesy to the patient.

5. Dorothy DeWees Says:
   March 4th, 2010 at 8:18 am

   It may be a “hassle” but there’s more than the 20% at stake here. The affected claims are ones processed to the deductible and could amount to a great deal over the course of a month. It’s definitely worth the hassle to copy and file these claims.

6. Sheena Roseboro Says:
   March 8th, 2010 at 6:44 pm

   I have retrieved EOBs, attached copies and sent them to secondary payers, unaware that they weren’t crossing over. Where does Medigap come into play here?

7. DeVona Haight RN,CPC Says:
   March 9th, 2010 at 2:45 am

   When our intermediary was contacted about this issue, the response was”new policy requested by the secondary carriers-they ask that Medicare stop forwarding claims with deductibles and paid in full balances”. Another example of incorrect information passed on from employees of the intermediaries. Is anyone surprised???

8. Michelle Says:
   March 9th, 2010 at 9:28 am

   Medicare, Palmetto and Tricare will not accept the usual HCFA 1500. Needs to be a new type of form with special red ink in the printer. So if they don’t crossover, the patient gets the bill to submit themselves. Now with the more than 20% decrease in reimbursement, we cannot afford to do anything over and above for any of the above mentioned insurances. Solo practioners and being hit hard!

9. Kayo Says:
   May 2nd, 2011 at 8:48 am

   Never seen a bteetr post! ICOCBW

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