General Question for the Week of December 14, 2015

General Compliance Question of the Week

Question:

When will CMS fix the problem with claims denied due to inaccurate NCD information? 

Answer:

With respect to the national coverage determinations (NCDs), claims inappropriately rejected or denied have been automatically reprocessed in most cases, and no action is required by the provider, according to the Centers for Medicare & Medicaid Services (CMS). The agency stated that it implemented interim solutions, and a permanent systems’ update should be in place by January 4, 2016. Information about specific claim types and the reprocessing of claims is available on individual Medicare administrative contractor (MAC) websites. 

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.