This table displays Part A and Part B processing issues that are being worked currently or have been resolved recently.
The Centers for Medicare & Medicaid Services (CMS) has identified overpayments related to change request (CR) 9479 and CR 9601, which caused reimbursement to be applied to non-covered drug Healthcare Common Procedure Coding System (HCPCS) lines on Outpatient Prospective Payment System (OPPS) claims for claims with receipt date on or after October 1 2016, and dates of service on or after January 1, 2016, through March 6, 2017.
The Centers for Medicare & Medicaid Services (CMS) has instructed Medicare administrative contractors to adjust CCM claims for rural health clinics (RHCs) and federally qualified health centers (FQHCs) that were processed incorrectly.
First Coast has identifed certain Part B claims billed with modifier JW as being rejected in error as duplicate changes. Affected claims will be adjusted.
First Coast has become aware of processing issues for pneumococcal and influenza vaccinations where in some instances the vaccination is not being priced, and in other instances, the vaccination is being priced; however, coinsurance is being applied in error. Affected claims will be mass adjusted.
There are no items in this section at this time.
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