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Home Health & Hospice Week

Reimbursement:

PROVIDERS GET A BREAK FROM NAME/ID EDITS

Published on Mon Aug 08, 2005

Patient nicknames won't be the bane of your billing anymore.

Pressure from thousands of providers has led the Centers for Medicare & Medicaid Services to reverse an edit that was causing massive denials.

Since CMS instituted an edit requiring providers to match Medicare beneficiaries' names and Medicare ID numbers exactly, some providers have had as many as 30 percent of their claims denied. But now CMS officials say the edit is being deleted for now.

Officials say they decided the edit was "too restrictive," perhaps because of the excessive number of denials. CMS hasn't announced the change publicly, except to revoke a Medlearn Matters article about the requirement (SE0516).

But you can't kiss the edit goodbye forever - the agency is reworking it, and plans to reinstate a revised version at some point in the future.

For now, though, providers and billing experts rejoice at the disappearance of the troublesome edit. "This one issue has created more aggravation and denied claims to Medicare than any other reason recently," says Susan Callaway, an independent auditor and trainer in North Augusta, SC. "Medicare has obviously realized that the requirement created more work for them as well," Callaway concludes.

"The Medicare program dramatically underestimated the impact or side effects of this change," says consultant Bob Burleigh with Brandywine Healthcare Services in Malvern, PA.

The edit meant denials "anytime a human error is there in typing or spelling of a name, even missing a middle initial," Callaway complains.

Or sometimes a patient will be named Margaret but the provider will bill using the name Maggie, experts note. And patients who don't like their first name just use their middle name.

But billing experts agree that some means of verifying patients' identities could be a valuable anti-fraud mechanism. CMS could reinstate the edit for date of birth, Social Security Number and Medicare number, but not name, for example.

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