(855) Marcum1 | FOLLOW US  
Marcum LLP
Insights

Healthcare Alert

 

In This Edition

Part A Provider Coordination of Benefits Error Code 000000

Share:

CMS has learned that Part A providers (such as hospitals, skilled nursing facilities, home health agencies and hospices) may be receiving paper notices (114 Reports) from their Medicare Administrative Contractor (MAC) that contain error code “000000,” with no further information as to why their patients’ claims cannot be crossed over to supplemental insurers. This sometimes happens when the CMS Benefits Coordination & Recovery Center (BCRC) makes an exception to its H25407 compliance edit (“Admitting diagnosis must be used because this claim is for inpatient services.”) for HIPAA 837 version 5010A2 claims. This exception is made for 21x type of bills, for example, in accordance with current CMS claims processing policy.

Providers that bill 11x and 18x type of bills to Medicare should include an admitting diagnosis code on their incoming claims. Providers that receive letters from MACs that contain error code “000000” will need to balance bill their patients’ supplemental insurers.

 
 
 
 
HAVE A QUESTION? ASK MARCUM
 
STAY IN TOUCH.

SIGN UP TODAY FOR MARCUM'S NEWSLETTERS.

ABOUT MARCUM LLP

Marcum LLP is one of the largest independent public accounting and advisory services firms in the nation, with offices in major business markets throughout the U.S., as well as Grand Cayman, China and Ireland.

Learn More

CONNECT WITH US
OFFICES

Headquarters
750 3rd Avenue, 11th Floor
New York, NY 10017

Find an Office

(855) MARCUM1
info@marcumllp.com

FOUNDATION

Marcum Foundation

AFFILIATIONS

Leading Edge Alliance