Wiki Medicare Corrected Payments - Please Help!!

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mgord

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We have recently ended our contract with our outsourced billing office to bring all the billing back in house. Our office mgr is supposed to be a billing expert but I'm starting to notice some things that just dont seem to add up to me.

The biggest thing I'm seeing is that we have started getting all of these corrected payments where MCR is reversing their original pymt and paying back out at the corrected rate from Jan 2010. This has left a ton of accounts on our 120- AR with these tiny little balances or even credits. Since the new MCR ERAs dont say that the claims were forwarded to the secondary, I have been printing these out and filing to the 2ndary payers with these new ERAs with the corrected payments.
However I was told today that we didnt have to do this unless we really expected to get any payment.
Is this right? Does anyone have any suggestions on how we should handle these? Any help would be greatly appreciated!
 
Your choice of thinking to send the MCR ERA to the secondary payor is good based on the fact that you are confronting a situation that if not tended to will only become a worse problem in the future. However, you did not state if the adjusted Medicare rate was a lower or higher rate. This makes a difference. I am also assuming that you did not receive any additional payment from Medicare based on your managers response. If the adjusted rate is higher,then Medicare owes you money and thus the secondary owes you money as well. But since you have not received any payment, then it wouldn't be wise to contact the secondary right now. Nothing is for sure until you receive payment. If the adjusted rate is lower, then you owe Medicare money and thus you owe the secondary money as well. In that case, it would make sense to contact the secondary now so that you can begin the refund process. :)
 
We have been sending these to the secondary and have been receiving payments from most of them. Others deny them as duplicates :( . So frustrating for such a little amount. I hope this doesn't go on much longer!
 
We post these adjustments to a miscellaneous account as a lump sum. Sorry but printing and mailing a claim to collect a nickel is nonsense. Any corrected payment received from Medicare should just be considered a bonus in my view. CMS does not require you to go after copays that cost more to collect than they are worth.
 
Medicare

We too have been receiving these adjustments. I am not billing the secondary since it is usually only pennies. We have also received payments from secondary carriers. I am going to adjust off the pennies after 45 days allowing secondary carriers to reply. Tricare will not send payment for less than 1 dollar. Yes it is alot of work for little money.
 
Careful with Tricare as they have been sending a duplicate payment for the new adjusted amount after having the medicare adj forwarded from them. We have been keeping an eye on the tricare checks and if they are a double payment we send the check back.
 
We put payments to miscellaneous and did not file to secondaries. If they paid good and if not we didn't file. Would have spent more money than we would have received.
 
It does depend on the carrier for our office and the amount. If it is a very small balance, it just really isnt worth your time, the price of a stamp, the HCFA and the envelope to collect such a small balance. We usually dont bill the secondary for these small balances. Medicare will also often send the corrected pmt info to the secondary anyways so if we do get a payment we consider it a bonus from the secondary.
 
ACA Medicare Adjustments

Change Request (CR) 7011, "Reprocessing Claims to Comply with the Patient Protection and Affordable Care Act." This CR addressed claims reprocessing requirements for claims affected by the retroactive nature of various provisions of the Affordable Care Act as well as retroactive corrections to the 2010 Medicare Physician Fee Schedule (MPFS). Medicare is reprocessing claims to comply with the ACA. In most cases the Medicare contractors are reprocessing these claims automatically, unless the charges submitted were less than the revised 2010 fee schedule. So far I have not had to send anything to secondary payers, so apparently Medicare is forwarding the information to them as usual.

The best explanation for this I have found on the internet is at www.eyecareamerica.org. Here is a link:

http://www.eyecareamerica.org/aaoesite/promo/coding/upload/CMS_Affordable_Care_Act_Provisions-2.pdf
 
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