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News & Press: Insurance/Provider

Medicare Claims Update

Friday, February 14, 2020   (1 Comments)
Posted by: Sheri Ryan
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Many offices have reported an influx of Medicare claim denials received in the past 7-10 days for chiropractic services with remittance referring to the LCD (N115) or non-covered services. Many of you have spoken with Noridian provider relations, receiving a variety of explanations from diagnosis coding no longer valid to computer glitch and that the issue is internal to Medicare and that they are working on it. Provider relations told others that it might take a couple of weeks to resolve the issue.

ACS reached out to the other states in Jurisdiction F to see if they too were affected by this increase in blanket Medicare claims denials.  Washington, Montana and North Dakota have reported experiencing similar situations. 

North Dakota has been in contact with the local Medicare leadership, who has confirmed to them that there is an internal problem with processing that they are working to resolve. Per the North Dakota Chiropractic Association, there are two important points to pass along that should be helpful:

  1. You will NOT need to re-submit any of the claims denied due to the error.
  2. You will NOT need to appeal any of the claims denied due to the error.

Some offices have chosen to hold claims, and others have continued to submit to Medicare. It's up to you to decide what works best for you and either choice appears to be acceptable to Medicare. There is not an expected timeline for resolving the problem, but we will continue to follow up on the situation.  

Montana has been in contact with their contacts at Noridian and their contacts assure them it is NOT a coding issue.  The issue has been identified and claims are being reprocessed automatically.  They were told to watch the situation and make sure claims were re-processed in 90 days.  If not, then call the claim center. Montana was told the date of the fix is February 7 and claims after that should process correctly.

I encourage you to review your denied claims to make sure that there are not inadvertent errors (2019 vs 2020 dating), billing of non-covered services (unless you are seeking denial for secondary insurance billing), incorrect diagnosis code order, etc. so as to weed out any claims that will be denied upon automatic re-processing.  

Thank you to the ACS Member offices who reported the situation to our office.  We count on our members to report these situations so we can keep apprised of trends across the state and investigate quickly for a solution!  

Sheri Ryan  |  Chief Operating Officer

Alaska Chiropractic Society | 550 E. Tudor Rd., Suite 202 |  Anchorage, AK 99503

Direct/Mobile: (907) 903-1350 | Fax: (907) 770-3790

sryan@akchiro.org | Facebook  |  Twitter  | Website

 

Ensuring Chiropractic is the first Healthcare Choice in Alaska!

Comments...

Sheri Ryan says...
Posted Monday, February 17, 2020
This in from Noridian - Please let providers know Noridian has found the root cause of the inappropriate denials for chiropractic services with dates of service (DOS) 01/01/20 and after. The fix was put into production on 02/07/20 so claims received as of this date will process correctly. Noridian requests providers not resubmit denied claims as all inappropriately denied claims with DOS of 01/01/20 and after will be adjusted. If providers have not received payment within 90 days of this notice please contact the Provider Contact Center at 877-908-8431.

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