May 20, 2013

A Failure to Communicate: Midwestern MAC Prepared to Accept Part A-to-Part B Re-bills

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Contrary to what was widely believed as recently as just last week, the Medicare Administrative Contractor (MAC) for a handful of Midwest states is in fact prepared to accept Part A-to-Part B re-bills.

A representative with Wisconsin Physicians Service (WPS) reportedly indicated that the issue appears to be tied to temporary billing instructions from the Centers for Medicare & Medicaid Services (CMS), which in March issued Ruling 1455-R, a decision establishing an interim process for hospitals to bill Medicare for Part B services following a denial of a claim for an inpatient admission deemed not reasonable and/or necessary. 

“She (the WPS representative) believes that the issues with the rejected claims that were submitted (by) my facility, and by other facilities, were related to following the original CMS temporary billing instructions,” McLaren Greater Lansing Hospital Compliance Audit Coordinator Sandra Palmer explained in an email. “She acknowledged that no statement was ever sent out by either CMS or WPS to alert facilities that the instructions had been revised. The CMS-revised instructions do not have a revision date, so no one is sure how recently they have been revised.”

Palmer last week had indicated that a WPS customer service representative told her and multiple billers at her facility that the contractor only would be ready to accept Part A-to-Part B re-bills when the final rule goes into effect – and at least three other facilities in Michigan were told the same, she reported. But when she followed up, a WPS manager reportedly apologized for the “misinformation” and noted that all customer service representatives will be informed about the situation.

It was something of a critical mix-up, as providers in the WPS coverage regions were concerned that they wouldn’t be able to take advantage of the interim rule, which also lifts certain timely filing requirements.  It isn’t yet clear when the final rule will go into effect. Last week, when confusion about the matter still persisted, healthcare attorney Andrew Wachler of Wachler and Associates even indicated that he had recommended to clients that they submit several Part B claims just to evaluate the process before dismissing any appeals.

The revised CMS temporary billing instructions can be accessed online at http://www.cms.gov/Center/Provider-Type/Hospital/Other-Content-Types/Quick-Reference-CMS-1455-R.pdf. As for the final rule, Palmer noted that some are speculating a date of July 1, but that isn’t set in stone.

“What will go into effect July 1 is CMS Change Request CR 8185, which replaces the temporary billing instructions,” Palmer added. “The implication, but certainly no definite statement, was that the final rule would not be effective on July 1, and that facilities would still have some time to get re-bills in after July 1 and before the final rule.”

Palmer was incredulous regarding the recent apparent shift in temporary billing instructions, which flew far under the radar of multiple providers.

“I am on several mailing list-servs, and watch every day for anything regarding RACs, and especially the Part A-to-Part B re-bills, and I never saw any alert or notification of the revised instructions. CMS apparently did not change the Web link; they just switched one set of instructions for another,” she noted. “The good news is that, per the WPS manager of outreach and education, they are accepting the Part A-to-Part B re-bills now, provided that qualifying claims are completed according to the new instructions.”

Palmer added that she has notified her counterparts within McLaren’s multi-hospital system in the Lansing, Mich. Area, and also one other hospital in Lansing.

WPS recently lost a protest of the MAC award for Jurisdiction 6 to NGS, which is scheduled to take over for that area in mid-September.

About the Author

Mark Spivey is a national correspondent for RACmonitor and ICD10monitor.

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mcspivey@hotmail.com.

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Related Article:

MAC Won't Accept Part A-to-Part B Rebills

Mark Spivey

Mark Spivey is a national correspondent for RACmonitor.com who has been writing on numerous topics facing the nation’s healthcare system (and federal oversight of it) for five years. 

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