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CMS Offers Advice for Conditional Payment Administration

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Medicare Set Aside News - CMS Offers Advice for Conditional Payment Administration

Through the Medicare Learning Network (MLN), CMS offers helpful advice to providers and claim professionals regarding claim submissions.

Medicare is denying an increasing number of claims because providers are not identifying, nor sending claims to, the correct primary payer prior to claims submission. Medicare is reminding providers, physicians, and suppliers that they have the responsibility to bill correctly and to ensure claims are submitted to the appropriate primary payer. Please refer to the "Medicare Secondary Payer (MSP) Manual," Chapter 1, Chapter 3, and Chapter 5 and MLN Matters® Article SE1217 for additional guidance.

The guidance provides clarification in the procedures for processing liability insurance (including self-insurance), no-fault insurance and Workers Compensation Medicare Secondary Payer (MSP) claims. Medicare is now able to identify these claims in their systems and deny them if improperly submitted. Change Request (CR) 7355, clarifies the procedures when billing Medicare for liability insurance (including self-insurance), no-fault insurance, or WC claims, when the liability insurance (including self-insurance), no-fault insurance, or Workers Compensation carrier does not make prompt payment. It also includes definitions of the prompt payment rules and how contractors will identify conditional payment requests on MSP claims received from the providers. All claim practioners and provider billing staffs should be aware of these Medicare instructions.

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