More Medicare claims problems

On the heels of recent news that some Medicare administrative contractors (MACs) were inappropriately denying pneumococcal vaccination claims using local frequency edits comes the revelation that all MACs are experiencing an issue with the Medicare eligibility contractor, also resulting in incorrect claim denials. This claims processing error was first reported on October 9, 2019, and involves invalid entitlement dates for all beneficiary entitlement periods, which is causing claims to be incorrectly denied based on invalid beneficiary entitlement.

There is no word on when the problem is expected to be resolved, but MACs are reporting that they anticipate a correction for this issue soon. Impacted claims do not need to be resubmitted; they will be held and released once the correct entitlement data is available.

For additional status information, physicians and others who bill Medicare are encouraged to check the Production Alerts section of their MACs’ websites, like the one for National Government Services (NGS), and communications from their MACs.

— Kent Moore, Senior Strategist for Physician Payment at the American Academy of Family Physicians