RCPA - Rehabilitation and Community Providers Association


Medicare Physician Fee Schedule Claims Errors
May 3, 2010

Highmark Medicare Services issued an alert regarding claims errors related to the continuation of a zero (0) percent update to the Medicare Physician Fee Schedule through May 31. Highmark had held Part B claims with dates of service April 1 and later. Claims were paid for dates of service April 1 or later that were received between April 1 – 7, but a systems error caused the claims to be paid at the original -21 percent reduced fee scale, rather than the -0 percent fee scale. Highmark continues to pay claims rolling forward. A claims adjustment process was implemented to correct the claims paid error. Claims adjustments for Maryland; Washington, DC; and Delaware should be paid correctly by May 7. Pennsylvania and New Jersey claims continue to be adjusted with expected completion by May 5. Highmark will continue to monitor claims and perform automatic adjustments if incorrect payments are identified.

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