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Medicare Compliance & Reimbursement

PHYSICIANS:

CMS Puts Temporary Nix On Name/ID Denials

Published on Mon Jul 18, 2005

Medicare gives up on edit until further revision.

Pressure from thousands of providers has led the Centers for Medicare and 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 physicians can't kiss the edit goodbye forever - the agency is reworking it, and plans to reinstate a revised version in the future.

But for now, 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 coding auditor and trainer in North Augusta, SC.

"Medicare has obviously realized that the requirement created more work for them as well," Callaway concludes.

CMS might have expected that problems would subside as physicians became accustomed to the new requirement. In fact, "claims rejections have been increasing, but not to a point where it was critically impairing financial status of the physician," notes Michelle Logsdon with Falcon Practice Management in Bayville, NJ.

"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 for every error in typing or spelling of a name, even missing a middle initial.
 
"There are too many points to match for the claim to get paid," says Logsdon. "For a physician's office, it is easier to get a copy of the Medicare card and ensure that the information matches exactly.

"But my surgeons, who get information from hospital face sheets, don't have that luxury," Logsdon explains.

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