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CMS fixes error code, but payment catch-up for dialysis providers will last through November
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The Centers for Medicare & Medicaid Services has begun processing claims rejected earlier this month due to an error code in its Outpatient Prospective Payment System, but dialysis providers won’t see all the delayed payments until next month.
The National Renal Administrators Association first told its members on Oct. 11 that CMS’ effort to implement an Oct. 1 update to the OPPS resulted in an incorrect rejection of dialysis claims. The NRAA says the claims were identified in Medicare’s online system (DDE) or on Clearinghouse status reports as “Reason Code W7099 – Claim with pass-through or non-pass-through drug or biological lacks OPPS payable procedure (Return to Provider (RTP).”
The Medicare Administrative Contractors (MACs), which authorize payments to dialysis and other health care providers, were instructed to perform a workaround that will allow claims to be processed correctly. The MACs will reprocess any claims that were incorrect. The delay in fixing the error code, however, means dialysis clinics won’t see payments originally due this month until November. -by Mark Neumann