We are hearing a lot about the Cures adjustments these days... But there are a few developments you really need to know.
If you received denials for oxygen contents (E0443) after adjustments, those claims were mass reprocessed on August 14th therefore you should see new remittance advices. You can expect to see miscellaneous code “E1399CC” on oxygen claims impacted by Cures if a new CMN replaced an older CMN. A different HCPCS code from the original claim may disrupt billing software’s auto-posting feature. Providers have reported a potential systems issue resulting in low or negative reimbursement for E0562 humidifier rentals after adjustments. The MACs have confirmed they are aware of the issue in recent ACT calls. MiraVista suspects this is related to a systems calculation issue related to CMN payment tracking. Be on the lookout for potential errors and call customer service to reprocess these claims, or send to written reopenings when multiple claims are affected.
Generally speaking, most secondary payers do not accept adjusted crossover claims. 100% of the Cures adjustments fall into this category that is often excluded. Billing staff need to target and manually re-transmit these newly opened secondary claims. Otherwise they will be lost in your Aging report. Furthermore, newly opened patient balances will increase customer service calls. Are your CSRs able to explain these balances in a customer-friendly way so patients understand? You could prevent some of these calls by adding a footnote to patient statements that explains this increase in activity is the result of the Cures Act directives. A little background and context will go a long way!
Make sure your payments and billing staff are in the loop with these system nuances and position them for success in this complex web of activity.
If you received denials for oxygen contents (E0443) after adjustments, those claims were mass reprocessed on August 14th therefore you should see new remittance advices. You can expect to see miscellaneous code “E1399CC” on oxygen claims impacted by Cures if a new CMN replaced an older CMN. A different HCPCS code from the original claim may disrupt billing software’s auto-posting feature. Providers have reported a potential systems issue resulting in low or negative reimbursement for E0562 humidifier rentals after adjustments. The MACs have confirmed they are aware of the issue in recent ACT calls. MiraVista suspects this is related to a systems calculation issue related to CMN payment tracking. Be on the lookout for potential errors and call customer service to reprocess these claims, or send to written reopenings when multiple claims are affected.
Generally speaking, most secondary payers do not accept adjusted crossover claims. 100% of the Cures adjustments fall into this category that is often excluded. Billing staff need to target and manually re-transmit these newly opened secondary claims. Otherwise they will be lost in your Aging report. Furthermore, newly opened patient balances will increase customer service calls. Are your CSRs able to explain these balances in a customer-friendly way so patients understand? You could prevent some of these calls by adding a footnote to patient statements that explains this increase in activity is the result of the Cures Act directives. A little background and context will go a long way!
Make sure your payments and billing staff are in the loop with these system nuances and position them for success in this complex web of activity.
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