Sunday, October 31, 2004

Determining patient assignment
With Clay Stribling

Q. Recently my explanation of benefits forms (EOBs) from Medicare contained a new statement indicating that, effective Oct. 1, 2004, claims filed for Medicare/Medicaid beneficiaries must be filed assigned. What is the effect of this policy change and how will my claims be affected?

A. Earlier this year, CMS modified the process that carriers will use for coordinating benefits for Medicare beneficiaries who have Medicaid as secondary coverage. As a result of these changes, CMS implemented a new initiative known as the Coordination of Benefits Agreement (COBA) consolidated crossover process. Effective Oct. 1, 2004, claims for beneficiaries who have Medicare as their primary coverage and Medicaid as their secondary coverage, must be billed to Medicare on an assigned basis. If the non-assigned claim is submitted, and the carrier can determine that the non-assigned claim’s service date falls during a period in which the beneficiary is eligible for Medicaid, the carrier will convert the assignment indicator from non-assigned to assigned and re-transmit the claim to the common working file.

As in most processes for monitoring and altering claims, this could cause significant delays in the processing of claims for those who have Medicare as primary and Medicaid as secondary coverage.

Therefore, suppliers should implement procedures to monitor claims processing and verify that claims that are submitted to Medicare with Medicaid as a secondary payor, are submitted on an assigned basis.

Contact Clay Stribling, Esq., an attorney with the Health Care Group of Brown & Fortunato, at (806) 345-6346 or