Sunday, August 31, 2003

You’ve got mail: DMERCS advise
With Karen Moore

Q. Previously suppliers did not receive a remittance advice for claims submitted unassigned. Is it true that the DMERCs are now sending the supplier a remittance advice for unassigned claims?

A. Suppliers will receive a remittance advice from the DMERC for all unassigned claims that have been denied. This change in processing policy for unassigned claims is effective for claims processed on or after July 1, 2003 for dates of service on or after Jan. 1, 1995. Additionally, an ABN is now required for items that have the potential for coverage but the supplier believes Medicare will not cover for both assigned and unassigned claims.

The GA modifier is to be used on all line items where a properly executed ABN has been obtained for both assigned and unassigned claims. If an item which has the potential for coverage is denied and an ABN was not obtained, the remittance advice for an unassigned claim will inform you to refund the patient whereas the remittance notice for an assigned claim will indicate that the patient may not be billed for this amount. If you receive notice of a denial on an unassigned claim where an ABN was not obtained for a potentially covered item, and you believe the item was denied in error, you should request a review within 30 days in which case refunding the beneficiary can be delayed until the results of the review are received. If you do not request the review within 30 days, you must refund the beneficiary, however, you still have 120 days to submit a review.

Karen Moore is a vice president of Ancor Healthcare Consulting. Reach her at 954-757-3121.