This table displays Part A and Part B processing issues that are being worked currently or have been resolved recently.
It had been discovered that the prior integrated outpatient code editor (IOCE) was incorrectly applying deductible and coinsurance to HCPCS code G0473. This article was revised to reflect that the IOCE update has been implemented and Medicare administrative contractors will initiate mass adjustments no later than March 3.
Due to the October implementation of 2017-2018 influenza vaccine payment allowances, the Centers for Medicare & Medicaid Services has directed contractors to reprocess claims that were processed on or after August 1.
In light of Hurricane Irma impacting Florida, Puerto Rico, and the U.S. Virgin Islands and disaster-related claims being billed, Part A providers are unnecessarily reporting OSC 70 on SNF claims billed with the CC DR/Modifier CR, resulting in rejection. Learn what to do to avoid this rejection of disaster-related claims.
Claims are rejecting in error with CWF reason codes U6816, U6817, and U6818 when Part A claims are billed with the applicable CARC codes listed in CR 8984 and CR 9009 which permits a residual payment if the services billed are covered and payable by Medicare.
Some providers may notice a difference in how deductible and coinsurance amounts are being displayed on the remittance advice for QMB claims. CMS will revert back to the previous display on December 8, and until then, CMS has provided a guide to identify Medicare cost-sharing amounts on remittance advice. No provider action is required.
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