Tuesday, November 5, 2013

Claims Processing Issue Causing Overpayments

CGS (a Medicare Administrative Contractor) has identified a claims processing issue that results in an overpayment displayed on your remittance advice (RA). In these cases, the overpayment amount is reflected either in the adjustment to balance field on the standard paper RA or as adjustment reason code 90 on the electronic remittance advice (ERA). CGS is awaiting further direction from the Centers for Medicare & Medicaid Services (CMS) regarding collection of these overpayments. Providers are encouraged to track the dollar amount associated with the overpayment and the RA/ERA paid date, as CGS anticipates a future recoupment may occur. We do not recommend providers reporting this overpayment on their credit balance report. Please monitor future CGS listservs for additional updates on this issue.

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