Part A Incorrect Dialysis Payments
National issue that also impacts Part A ESRD providers in Jurisdiction K and Jurisdiction 6
Description of Issue
We have recently become aware of an issue which began on 7/15/2024 where ESRD claims with demo code 94P were finalizing with incorrect payment amounts (overpayments as well as underpayments). The incorrect payment amount is a result of FISS inappropriately calculating the provider’s Medicare reimbursement to include the patient responsibility amount. The patient responsibility amount is the amount that is billed to and paid for by the patient or a supplemental insurance.
National Government Services Action
There will be a nationwide fix for this issue added to the 10/7/2024 FISS system release. NGS will implement this fix and determine the number of impacted claims.
Provider Action
No provider action is indicated at this time, however, please continue to monitor the Production Alerts section of our website and future Email Updates. Once NGS has determined the number of impacted claims, this Production Alert will be updated to advise if a mass adjustment will be performed or if providers will need to adjust their impacted claims.
Proposed Resolution/Fix
Issue is expected to be corrected with 10/7/2024 FISS system release.