RESOLVED: Incorrect Denials Indicating Skilled Nursing Facility (SNF) Consolidated Billing (Includes Ambulance Services)

Current Status
9/14/2018: All adjustments for Jurisdiction J, Jurisdiction M and Railroad Medicare have been completed.

Issue Identified 3/1/2018
CMS notified Medicare Administrative Contractors (MACs) of a Common Working File (CWF) issue causing certain allowable services with dates of service January 1, 2018, through February 27, 2018, to deny incorrectly indicating the service is part of Skilled Nursing Facility (SNF) Consolidated Billing (CB). In some cases overpayment demand letters were issued for claims that were previously paid. The CWF issue was corrected with the nightly cycle on February 27, 2018. 

Status:

9/14/2018 –
All adjustments for Jurisdiction J, Jurisdiction M and Railroad Medicare have been completed.

6/28/2018: The Railroad Medicare adjustments for claims that were initially denied in error for this issue have been completed. Any claim that initially paid and was subsequently identified incorrectly as an overpayment due to this issue and resulted in an overpayment refund request has not been adjusted. Palmetto GBA must wait for further guidance from CMS to address adjustments where monies have already been recouped or refunded due to incorrect overpayment refund requests related to this issue.

5/25/2018: The Jurisdiction J (Tennessee, Alabama, Georgia) Medicare claim adjustments have been completed and will continue through the claim processing system.

5/22/2018: The Railroad Medicare claim adjustments have been completed and will continue through the claim processing system.

5/16/2018: The CPIL title was updated to alert ambulance providers that some of their transports may be affected by this issue.

5/4/2018: CMS clarified this issue affects claims processed January 2, 2018, through February 26, 2018, and MACs are instructed to complete adjustments related to this issue within 150 days. Additionally, MACs are instructed to suspend working refunds associated with this issue and to wait for further guidance on addressing adjustments where monies have already been recouped or refunded due to incorrect overpayment refund requests related to this issue.

Provider Action:
3/2/2018: There is no provider action necessary at this time. Affected claims will be reprocessed. Recoupment of any money demanded for previously paid claims due to this issue will be halted and/or returned to providers in accordance with any further instruction from CMS.  This CPIL will be updated when further direction is received from CMS.

Note: Not all claims denied as SNF CB or refunds requested due to SNF CB are incorrect. When a patient is in a covered Part A SNF stay, Part B Medicare can only cover services identified as excluded from SNF CB. Visit the CMS SNF CB webpage for a listing of those services.

Contact Palmetto GBA JM Part B Medicare

Email Part B

Contact a specific JM Part B department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

Other Palmetto GBA Sites

Palmetto GBA Home

DMEPOS Competitive Bidding Program

Jurisdiction J Part A MAC

Jurisdiction J Part B MAC

Jurisdiction M Part A MAC

Jurisdiction M Part B MAC

Jurisdiction M Home Health and Hospice MAC

MolDX

National Supplier Clearinghouse MAC

PDAC

RRB Specialty MAC Providers

RRB Specialty MAC Beneficiaries

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