Healthcare Provider Solutions



This Monday Minute emphasizes the importance of reconciling payments to your AR and the significance of the Medicare MAC claims processing issues logs.

Hi everyone, and welcome to our Monday Minute. Today I’d like to discuss with you the Medicare MAC claims processing issues logs. As your billers and collectors work through the process of reconciling the balances on your AR account to the remittance advices, where you’ve been paid by Medicare, it’s extremely important that it is confirmed that the amount you receive from the Medicare MAC in the form of payment is exactly what you expected. The amounts that are in your EMR systems should have been accurately calculating, assuming you’ve confirmed that the calculations are appropriate. If the payment that is received from the Medicare MAC is different from that amount, there needs to be a reconciliation to determine that the agency was paid appropriately. In the process of that reconciliation, and trying to understand the remittance advices, there are sometimes glitches that occur in the claims processing system that cause errors in what you are paid.  Sometimes it holds your claims, etc. and you’re checking for the status of claims in the DDE system. So, when we talk about the claims processing issues logs,on the Medicare MAC website, this is where they will show you any errors that are current to their Medicare MAC. It will give you in some cases, a timeline in which they expect to get that error corrected. In some cases, it’s going to say to be determined or we don’t have a date yet to fix it, but at least it will save you some time in having to sit on the phone to talk to the Provider Contact Center. In many cases, when you get to the Provider Contact Center, they may not have the answers. You really should be checking those claims processing issues logs on the MAC websites to see if there are errors that are known already by the MAC that they’re working on the corrections to save everyone, a lot of time and energy in trying to figure these things out.

In the details of the minute today, we will provide you a link to Palmetto GPA and CGS websites exact location of these error logs. We could not locate the NGS one before this Minute today, so you may need to look around, we think they may have moved it to the NGS Connex portal, so you might want to check there. We want to thank you all for participating today. We want to thank you for being there for patients during this public health emergency. We encourage you to stay in touch always with your state and national homecare associations and we hope to see you again soon.