Practice Management Alert

Pressure from thousands of providers has led the Centers for Medicare & Medicaid Services (CMS) 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 the time being.
 
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).

Look for the Edit to Return, Eventually

But you can't kiss the edit goodbye forever --  the agency is reworking it, and plans to reinstate a revised version later.
 
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, S.C.
 
-Medicare has obviously realized that the requirement created more work for them as well,- Callaway says.
 
-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 says.
 
Or sometimes a patient will be named -Margaret- but the physician office will bill using the name -Maggie,- experts say. 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 antifraud mechanism.
 
For example, CMS could reinstate the edit for date of birth, Social Security Number and Medicare number -- but not for name.