ICD-10 claims-processing errors continue to hit MACs

by: Richard Scott Nov 13, 2015

Three-quarters of the country's Medicare administrative contractors (MACs) have reported at least one ICD-10 claims-processing error, including a number of common procedures and services.

The latest count, based on ongoing Part B News analysis, shows that the claims-processing errors are holding up claims in at least 32 states. Common services tangled up in the unintential claims errors include mammography services (G0204, G0206) and a range of injection codes.

Some notable errors include:

Providers in 13 states — Alaska, Arizona, California, Hawaii, Idaho, Montana, Nevada, North Dakota, Oregon, South Dakota, Utah, Washington and Wyoming — have seen delays on mammography codes G0204 and G0206, which are associated with approximately $75 million in reimbursement nationally, according to the latest available Medicare claims data from 2014.
Practices in Florida, Puerto Rico and the U.S. Virgin Islands are coping with delays to claims involving injection code J0811 (Injection, darbepoetin alfa, 1 microgram [non-ESRD use]), which was billed 52 million times nationally, per 2014 claims data.
Ten states — Connecticut, Illinois, New York, Maine, Massachusetts, Minnesota, New Hampshire, Rhode Island, Vermont and Wisconsin — are dealing with hold-ups to several common injection codes, including high-volume pneumococcal vaccine codes 90670 and 90732, which saw national payment of more than $200 million in 2014.

View a full list of codes in the Nov. 16 issue of Part B News. Or view earlier reporting on ICD-10 errors here.

Blog Tags: CMS, ICD-10

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