Medicare Part B Secondary Payer Deductible Issues Resulting from Change Request #7026
Effective Friday, April 1, 2011, CMS implemented CR 7026 - Allowing the Common Working File (CWF) to accept both Medicare Secondary Payer (MSP) and Non-MSP Lines on MSP Claims and MSP Adjustment Claims. Medicare Part B claims processed after Friday, April 1, 2011, for which the beneficiary has a Medicare deductible remaining and Medicare is the secondary payer, are erroneously issuing payment despite the beneficiary's deductible not being satisfied or despite the total Medicare Allowed Amount being applied towards the deductible. The recovery of overpayments made during this time will be performed systematically. The recovery process has not yet been scheduled for implementation. In addition to these overpayments, Physical Therapy and Occupational Therapy claims processed after Friday, April 1, 2011 where Medicare is the secondary payer and a deductible is not met are being held up by the system and are not being paid. CMS anticipates both of these issues to be resolved in November 2011. -------------------------------------------------------------------------------------------------- Note: If you have problems accessing any hyperlink in this message, please copy and paste the URL into your Internet browser. If you know someone who would like to subscribe to a Medicare Fee-For-Service (FFS) provider listserv, go to (http://www.cms.gov/prospmedicarefeesvcpmtgen/downloads/Provider_Listservs.pdf). If you would like to unsubscribe from a specific provider listserv, please go to (https://list.nih.gov/cgi-bin/wa.exe?INDEX) to unsubscribe or to leave the appropriate listserv. Please DO NOT respond to this email. This email is a service of CMS and routed through an electronic mail server to communicate Medicare policy and operational changes and/or updates. Responses to this email are not routed to CMS personnel. Inquiries may be sent by going to (http://www.cms.gov/ContactCMS). Thank you.
