CMA continues to work with Palmetto and CMS on a global fix of the recent Medicare payment problems. In response to concerns previously raised by CMA, CMS approved and Palmetto has added 35 additional staffed phone lines that are supposed to be working by the end of the week. In addition Palmetto has committed to take the following actions:
On October 2 Palmetto will be adding an additional 15 phone lines that will be dedicated to provider enrollment issues.
Inquires that require research will be done off line and Palmetto has committed to us that calls will be returned within 24 to 48 hours.
Palmetto has added an issues update to its website: http://www.palmettogba.com/J1B (click on “Claims Issues Log” Under “Self Service Tools and Top Links”). This provides up-to-date listings to claim issues and other common problems.
Palmetto claims to be working on an email question and answer process to divert traffic from their clogged phone lines.
CMA is working with the media to publicize these problems and to put pressure on CMS to make many of the global changes to fix this crisis and to avoid all of the others that are, unfortunately, becoming commonplace in matters related to payment for Medicare services. CMA Vice President of Communigation Ned Wigglesworth has asked that you share your horror stories with him (nwigglesworth@cmanet.org), so that he can relay them to his media contacts.
CMA has compiled an updated list of common problems and fixes (below). Our purpose in sharing this list is to give county medical societies and individual practices the most up-to-date information available.
Pathology laboratories billing anatomical services with place of service 81 were being denied. This is different from the way physicians in the East submit their services, and Palmetto did not have it set up to pay. They have researched the regulations and have determined that place of service 81 can be used. They have updated their system and will reprocess those claims that were incorrectly denied.
Palmetto has posted a partial list of claims issues they encountered following transition. This list identifies the Local Coverage Determinations (LCDs) that were set up incorrectly. You can find this list on the home page www.palmettogba.com/J1B under Self Service Tools and Top Links, then click on Claims Issues Log, or on the Resources tab on the left navigation panel, near the bottom of the home page.
Other items to be aware of:
As of 9/16, Palmetto processed over 4,000,000 California claims and 3.75% have issues. Of that number, 5% are rejecting or being developed due to NPI issues. Most of these require enrollment applications to be submitted for corrections to be made. Most physicians have done that, and CMA is working with Palmetto to expedite applications for those who have encountered payment stoppages as of May 23 rd due to the NPI implementation.
Many physicians are calling to say they have not yet been paid. There could be several reasons.
Medicare cannot pay an electronic claim any sooner than 14 days from receipt. For claims submitted September 2, the earliest they could pay would be September 16.
Some claims may have suspended for manual review by Palmetto due to some of the edit issues they experienced. These may take longer than 14 days to settle. CMS allows contractors 30 days to settle a claim before they have to pay interest.
Paper claims must be held for 29 days before payments can be released.
EFT checks are posted shortly after the 14 th day for claims that have settled. Paper checks take 5 to 7 days mail time.
Physicians must use the IVR to determine the status of a claim. The IVR can also provide the financial information on the last three checks paid, and the number of claims approved to pay (and just waiting for the payment floor to be reached). The IVR cannot tell you when those checks will be generated.
Call volume for the Customer Service line, the EDI line, and the IVR continues to be exceptionally high, resulting in busy signals and callers being on hold for very long periods of time. CMS has allowed Palmetto to add additional lines and 35 new staff to help with the Customer Service lines. Part of this staff has just been placed on the phones, and additional staff will be available in a few weeks. In the meantime, we expect the busy signal and wait times to improve, but still be very high.
The number of enrollment applications is also exceptionally high due to the many projects requiring new enrollments. Palmetto recognized that applications for address changes were being delayed and resulting in payment issues for providers. They are running reports on the “do not forward” (mail returned) physicians identified in their enrollment system, and checking them against the applications submitted. They will work to expedite these applications.
CMA continues to encourage counties to use our Center for Economic Services (888/401-5911) for help resolving problems that are faced by members contacting county societies. CES has been able to resolve nearly all of the cases that have been referred to them, and in most cases they have been able to do so very expeditiously.
