RCPA - Rehabilitation and Community Providers Association


Medicare Issues Update
August 11, 2006

Medicare to Delay Claims Payment
The Deficit Reduction Act of 2005 requires Medicare to hold payments for all claims for the last nine days of the federal fiscal year which ends in September. Medicare will pay no interest or penalties on the funds that are held. Claims that would have been paid during the nine-day period will then be paid on October 2. The hold does not apply to denials or other claims that would not otherwise be paid. Medicare will apply the 14-day electronic claim and 29-day paper claim payment requirements, but Medicare fiscal intermediaries or carriers can make adjustments for extenuating circumstances. More information is available in MLNMatters (www.cms.hhs.gov/MLNMattersArticles/downloads/MM5047.pdf). Change Request 5047, available on the Centers for Medicare and Medicaid Services (CMS) web site (www.cms.hhs.gov/Transmittals/downloads/R944CP.pdf), provides more detailed guidance for fiscal intermediaries and carriers.

Eligible Beneficiaries Misidentified
Between July 24 – 27 the CMS 270/271 health care eligibility inquiry and response transaction used by providers to obtain beneficiary eligibility information returned Patient Not Found for beneficiaries that were actually entitled to Medicare. The problem was corrected on July 27. Highmark Medicare Services reports that approximately two million 270/271 transactions are processed each week and it was unclear how many transactions returned incorrect data. Highmark and CMS apologize for the problem.

Medicare Appeals Process Brochure Available
The Medicare Appeals Process: Five Levels to Protect Providers, Physicians and Other Suppliers has been updated and is now available to download from the MLN Publications page (www.cms.hhs.gov/MLNProducts/downloads/MedicareAppealsProcess.pdf). The brochure provides an overview of the Medicare Part A and Part B administrative appeals process available to providers, physicians, and other suppliers who provide services and supplies to Medicare beneficiaries.

Please contact Betty Simmonds with questions.

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