CMS has identified a Medicare claims processing system issue that is causing certain preventive services rendered in an institutional setting to be processed incorrectly. The following information pertaining to CAHs provides the action that will be taken by Medicare claims administration contractors:
§ CAHs (85X TOB) claims with dates of service on and after Sat Jan 1, 2011, containing HCPCS codes Q0091, G0101, 77052, 77057, and G0202 are being processed and paid incorrectly due to coinsurance being incorrectly applied. Medicare contractors have been instructed to hold claims impacted by this problem until a correction is implemented. A software correction is scheduled for June 2011.
As the software corrections are made, Medicare contractors will release any suspended claims and automatically reprocess claims for preventive services that have not been paid or erroneously applied deductible or coinsurance. Reprocessing of claims that have been paid incorrectly for this issue will be completed by Wed Aug 31, 2011. Providers who are billing for other payable services on the same claim as services that have been suspended and do not wish for their entire claim to be suspended may request the contractor to return the claim may remove the preventive service charge that is suspending until software corrections are implemented and then rebill an adjustment claim adding the preventive service that was initially removed.
