NOTES: Novitas Solutions plans a data consolidation to its financial accounting system June 16. This will not affect claims processing but may affect financial-related inquiries for one or two business days. Also note this upcoming Novitas 2017 Medicare Symposium: June 22 in Frisco. It's free, but you need to register.
New ABN: A revised version of Medicare Advance Beneficiary Notice (ABN), Form CMS-R-131, is set for use effective June 21. Although there are no changes to the form itself, the document now informs beneficiaries of their rights to Centers for Medicare & Medicaid Services (CMS) nondiscrimination practices and how to request the ABN in an alternative format if needed. The form also displays a new expiration date: March 2020.
Go to the CMS website to download the new version of the ABN (English and Spanish). Physicians should issue the ABN to patients in situations where Medicare payment is expected to be denied.
New remark codes for QMB patients: CMS has added three remark codes to readily identify a patient’s status as a Qualified Medicare Beneficiary (QMB). Patients enrolled in the QMB program are not liable to pay Medicare cost-sharing for all Medicare Part B claims, and the new codes reflect this. As appropriate, one or more of the following new codes will appear on the remittance advice for claims in which you have wrongfully collected coinsurance, deductible or copayments from a QMB patient:
- N781 — indicates no deductible may be collected,
- N782 — indicates no coinsurance may be collected, or
- N783 — indicates no copayment may be collected.
In addition, you’ll see the claim adjustment reason code 209 (“Per regulatory or other agreement. The provider cannot collect this amount from the patient. However, this amount may be billed to subsequent payer. Refund to patient if collected. (Use only with Group code OA [Other Adjustment]”). For details, see MLN Matters No. MM991 Revised.
If you have questions about billing and coding or payer policies, contact the specialists at paymentadvocacy[at]texmed[dot]org for help, or call the TMA Knowledge Center at (800) 880-7955.
Published June 14, 2017
TMA Practice E-Tips main page
Last Updated On
September 22, 2017
Originally Published On
June 13, 2017