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Last Modified: 6/12/2017 Location: FL, PR, USVI Business: Part A, Part B
Current processing issues for Part A and Part B
The table below provides an at-a-glance look at processing issues being worked currently or resolved recently. To sort by line of business (LOB), status, or date last updated, click on that column's header. Click again to change between ascending or descending order.
Provider Action
Last Updated
Part A
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 permit a residual payment if the services billed are covered and payable by Medicare.
Part A, Part B
Some providers may notice a difference in how deductible and coinsurance amounts are being displayed on the remittance advice for QMB claims. CMS reverted back to the previous display on December 8, and provided a guide to identify Medicare cost-sharing amounts on remittance advice. A permanent solution is tentatively scheduled for summer 2018.
None. Please refer to this article external website PDF file on the CMS website for a guide to identify cost-sharing amounts.
Part A
Deductible and coinsurance was being applied incorrectly for HCPCS G0473 (face-to-face behavioral counseling for obesity, 15 minutes) for TOB 13x for claims received on or after October 1, 2017. This was corrected with the January 2018 IOCE update release.
None. Medicare administrative contractors will mass adjust these claims no later than March 3, 2018.
Part A, Part B
Contractors are required to implement 2017-2018 influenza vaccine payment allowances no later than October 2. Once files are updated, reprocessing will occur for claims processed on or after August 1. Medicare administrative contractors (MACs) will initiate a mass adjustment process to reprocess claims by November 1.
There is no action required by the provider.
Part A
Providers are reporting occurrence span code (OSC) 70 with a date range 30 days or more before the skilled nursing facility (SNF) admission date (receiving reason code 11503) on claims with condition code DR or modifier CR. Providers should not report OSC 70 on claims billed with CC DR or modifier CR.
Remove the OSC 70 when reporting CC DR or modifier CR.
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