CMS Reminds to Allow 15 Working Days for Medicare Crossover Before Balance Billing Patients
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CMS Reminds to Allow 15 Working Days for Medicare Crossover Before Balance Billing Patients
The Centers for Medicare & Medicaid Services (CMS) reminds all providers, physicians, and suppliers to allow sufficient time for the Medicare crossover process to work—approximately 15 work days after Medicare's reimbursement is made, as stated in MLN Matters Article SE0909 — before attempting to balance bill their patients' supplemental insurers. That is, do not balance bill until you have received written confirmation from Medicare that your patients' claims will not be crossed over, or you have received a special notification letter explaining why specified claims cannot be crossed over. Remittance Advice Remark Codes MA18 or N89 on your Medicare Remittance Advice (MRA) represent Medicare's intention to cross your patients' claims over. Medicare will continue to issue supplemental notifications to all participating providers, physicians, and suppliers informing them if claims targeted for crossover, as evidenced by MA18 or N89 on the MRA, do not actually result in successful crossover transmissions.
Members of the supplemental payer/Medigap market are noting higher than average receipts of Medicare Part A paper claims that are preceding the arrival of Medicare's 837 institutional COB crossover claims. The arrival of paper claims in advance of Medicare crossover claims is resulting in supplemental payer receipt of duplicate claims. This trend is particularly pronounced among hospital providers within the states of Iowa, Missouri, and Wisconsin.
Current trending suggests that approximately 99 percent of all claims that Medicare identifies for crossover, as cited on your Medicare Remittance Advice, actually are crossed over by CMS' Coordination of Benefits Contractor (COBC). The remaining percentage error out at the COBC due to HIPAA compliance issues or related data errors, resulting in the provider, physician, or supplier's receipt of a Medicare-generated special notification letter specifying the reason for the claim's failure to cross over. This trending demonstrates that the crossover process is becoming more reliable all the time. The CMS requests that providers, physicians, and suppliers ensure that the trend continue.
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