Over the past 20 years I have used many different medical billing software programs, so I have extensive experience as an end user. I also worked for 2 companies that sold medical billing software, so I have considerable experience setting up Master Files and getting the programs running. SourceO...

Debra Janssen, Administrative Office Manager

Delay in Implementation of Automated MSP Adjustments

Delay in Implementation  of Automated Medicare Secondary Payer (MSP)  Adjustments (CR 6625) (201109-35)

On Friday, July 1, 2011, CMS implemented change request (CR) 6625 that created a systematic process in which Medicare automatically reopens/adjusts certain MSP claims when a beneficiary’s MSP claims record was deleted or an end date was applied to an open beneficiary MSP record. This automated process no longer required physicians, providers, and suppliers to contact their Medicare contractors to adjust or reprocess these types of MSP claims. CMS informed physicians, providers, and suppliers of these changes through a listserv message.

Due to systems issues currently affecting CR 6625, CMS directed its A/B Medicare Administrative Contractors, Durable Medical Equipment Medicare Administrative Contractors, and legacy contractors (FIs and Carriers) to immediately suspend all actions on this CR. This means that our Medicare contractors are unable to automatically reopen/adjust claims when Medicare takes action to delete or terminate a previously existing MSP record. Physicians, providers, and suppliers must revert to the pre-July 1 process and contact their Medicare contractor to request re-openings/adjustments of claims that were previously considered MSP. Therefore, if you have claims that were processed since July 1 that need to be reopened/ adjusted due to Medicare now being the primary payer, you should contact your local Medicare contractor to request that action.

CMS will alert physicians, providers, and suppliers once the current issues tied to the implementation of CR 6625 have been resolved.