Medicare Part B Crossover Claim Reprocessing

Florida Medicaid completed a review this past spring/summer of Medicaid claims reimbursed from 2008 through 2011 for Medicare Part B crossover claims and have identified that some claims were paid in error. Florida Medicaid has worked with its fiscal agent to correct the way the FMMIS processes the programming for payment of these Part B crossover claims.  These system corrections have been implemented over the past year, with all system modifications completed in spring 2012; consequently, claim payments are processing correctly.  Section 1903(d)(2) of the Social Security Act and the Florida Medicaid Provider General Handbook requires the Agency to recoup funds paid in error.  Providers affected by reprocessing will see claims adjusted in the Medicare Crossover Part B Claim Adjustments or CMS 1500 Claim Adjustments section of the Remittance Advice (RA) beginning in October 2012.  The Agency will also send individual letters to affected providers.