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.

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.

You already know that Jan. 1, 2012 is the deadline to implement the new ANSI 5010 standard for electronic transactions of HIPAA-protected data. But you might be wondering why CMS recently announced a delay in the “implementation of the PWK (paperwork) segment associated with [the test of the 5010] claim transaction originally scheduled for July and October 2011.”

 Nearly one in five of your private payer payments were inaccurate in 2011, according to the AMA's latest "National Heatlh Insurer Report Card," released June 20. The average rate of inaccurate payments is 19.3% in 2011, up from 17.3% in 2010, the AMA says. That 2% jump comes out to a $1.5 billion increase in administrative costs to the health system, the AMA estimates. "A 20% error rate among health insurers represents an intolerable level of inefficiency that wastes an estimated $17 billion annually," AMA Board Member Barbara McAneny, MD, said in a prepared statement.