Part B News | Editors' Blog

Dodgy edit spurs drug screen claims hold

by: Julia Kyles, CPC Jan 28, 2016

Proving that there's always room for more confusion where drug screen billing and coding is concerned, Medicare today announced that it is putting a hold on drug screen claims (G0477-G0483).

Some MACs announce 14 day claims hold in 2016 (Updated)

by: Roy Edroso Dec 28, 2015

~~Two~~ Three MACs serving 13 16 states, citing "technical errors discovered after publication of the MPFS rule," announce they're holding Part B claims for 14 days in early January. (See Update.)

Watch out for ICD-10 claims-processing errors

by: Richard Scott Nov 2, 2015

Six of the 12 Medicare administrative contractor (MAC) jurisdictions, entwining more than two dozen states and territories across the U.S., have reported at least one claims-processing error each, according to a Part B News analysis of the MACs’ publicly reported issues.

MAC transition to Highmark put on hold due to TrailBlazer protest

by: Ben Penn Dec 13, 2011

If you thought Highmark Medicare Services (HMS) was taking over as your new Medicare Administrative Contractor (MAC) next year, not so fast.

TrailBlazer Health Enterprises, which was set to lose its four-state Southwest jurisdiction to HMS, protested the MAC Jurisdiction H transition to the Government Accountability Office (GAO), leading the GAO to issue a stop work order to HMS on Nov. 28.

What this means for you: If you reside in Jurisdiction 4 or 7 – both set to transition over to HMS – you will continue to bill your current MACs until the GAO issues a ruling on the protest. The GAO must rule by March 1, 2012 at the latest.

Expect Medicare secondary payer overpayment demands

by: Grant Huang Aug 26, 2011

You can expect to see overpayment demands from CMS between now and November for Part B claims processed after April 1, 2011, the agency says. On April 1, CMS implemented a change request (CR 7026) that allowed its Common Working File to accept both Medicare as secondary payer (MSP) data and non-MSP data in claims adjustment lines. In English: Any patient who hasn't met the Medicare deductible, but has Medicare as the secondary payer, was issued coverage and had services paid as if the deductible were met, for claims processed anytime after April 1, 2011, CMS says.

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