Billing Beat

Claims Modifier Issues – Incorrect Processing for 2013 Services

January 28, 2013

Novitas has identified claim issues for dates of service 1/1/2013 through 1/11/2013. CMS informed Medicare claims administration contractors to hold Medicare Physician Fee Schedule (MPFS) claims with January 2013 dates of service for up to 10 business days (i.e., through January 15, 2013) until implementation and testing of the zero percent updated MPFS was completed and release claims that did not pay from the MPFS. Certain claim scenarios failed to suspended on this systems hold, and incorrectly completed processing. As a result of this system issue, Novitas has identified the following issues:

                        ·         Claims containing procedure codes with non-payable MPFS statuses finalized with the incorrect denial message

·         Modifiers 26, 50, 51, 54, 55, 78, 79, and TC were incorrectly removed and therefore may have denied or paid incorrectly
 

Novitas will identify and correct the affected claims. No action is required by the provider community.

Source: https://www.novitas-solutions.com

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