Monday, December 18, 2017

OCMA Blog

Noridian incorrectly denies 300,000 claims for E&M services

Last fall, the Centers for Medicare and Medicaid Services (CMS) experienced some editing issues with new patient E&M codes that resulted in incorrect claim denials. These problems started in October 2013, and was thought to have been corrected in late January 2014. The California Medical Association recently learned, however, that some claims continued to be paid incorrectly through July 15, 2014.
 
Noridian, California's Medicare contractor, in January began making mass adjustments and correcting claims subjected to overpayment recovery. Unfortunately, while implementing the corrections, Noridian inadvertently subjected established patient E&M codes to incorrect editing, resulting in incorrect denial of codes 99211- 99215.
 
Noridian has corrected the editing for both the new patient codes and the established patient codes, and claims received by Noridian on and after July 16, 2014, should be processing correctly. Noridian is now beginning the process of mass adjustments to the incorrectly denied claims. Due to the number of claims involved (~300,000 claims back to October of 2013), this process could take a month or so to complete.
 
Physicians do not need to do anything to have their claims adjusted and they should NOT resubmit the claims. The claims will be automatically adjusted.
 
For more information, see Noridian's notice on this issue.
 
Contact: Mitzi Young, OCMA Physician Advocate (888) 236-0267 or myoung@cmanet.org.

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