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Medicare Remit Posting a negative contractual adjustment amount

CPS, C-EMR, PM

Last Post by Anonymous 1 second ago

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ldement

(@ldement)

Posts: 3

Active Member

Topic starter

Hello All,

I have run into an issue with Medicare Remits posting a negative contractual adjustment CO-144. This is not posting correctly and leaves an "overpayment" since Medicare paid more than the allowable.

I have started a case with GE (01854525) and they are testing it but are not able to get the Contractual Adjustment to post as a payment. Is anyone else having these issues?

Any feedback would be helpful!

Lisa Dement

MedPeds Associates of Sarasota

Posted : February 7, 2018 4:45 am

acantu

(@acantu)

Posts: 722

Prominent Member

How is the data being imported into the system? If it is being imported from the 835’s (manual) or through the Centricity response import section, the error might be with the file they are sending back to you. Would really need to look at it to determine how to fix it and what is the exact cause, but to me it sounds like they are inputting the wrong data in the contractual field in the 835’s

Posted : February 7, 2018 5:04 am

ldement

(@ldement)

Posts: 3

Active Member

Topic starter

They are being imported through response management. The file and the paper EOB are the same. The problem is the CO-144 is shown on the EOB as a negative adjustment which is creating a positive (overpayment). The issue we are having is how to get what Medicare is calling a contractual adjustment (really incentive) to post like a payment without showing as an overpayment. Medicare made no adjustment to the allowable amount for these additional funds so there is nothing to post it against. Instead of taking this money away (like the sequestration) they are giving it to us. A very odd way I might add. I called Medicare. They said the file is correct and will continue to process it the same way. My remit settings handle all contractual adjustments the same, as an adjustment to the charge but the amount left over is an amount we never charged but additional compensation that makes it look like an overpayment on the ticket. I hope I am making this clear.

Posted : February 7, 2018 9:17 am

dennli

(@dennli)

Posts: 1

New Member

I am having the same issue trying to get the ticket to show the correct amount that is the patient responsibility after the remit is posted. I have tried changing my EDI set up to adjust the 144 and although the transaction itself shows no adjustment made - it does show in the Line Info and the Residual line shows the correct amount but the Insurance Balance shown is less the 144 amount...I can also see that the file being sent to a Secondary Insurance does show the 144 and the correct amount due but I know I will end up with a credit balance on the Insurance once the secondary pays.

If anyone has come up with a way to work around this, I would love to hear it.

Linda

Hallmark Health Medical Associates

Posted : February 4, 2019 7:40 am

lkeith

(@lkeith)

Posts: 457

Honorable Member

I think I would make another call and request to speak to a supervisor. What they are doing doesn't make sense at all. If it is really an incentive payment, why are they treating it like an adjustment that is taking money away.

Linda

Posted : February 4, 2019 8:54 am

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