Palmetto GBA (Government Business Administration) has informed the NCMS that the problem causing claims denials for Medicare patient office visits handled by physician assistants (PAs) and nurse practitioners (NPs) should be fixed this week. As we first reported in December, those denials were traced to a new policy based on a misinterpretation of Medicare guidelines. At that time, Palmetto GBA told us it would remove the erroneous edit from their system, retract the policy posted on their website, and reprocess all affected claims in a mass adjustment.

However, physician practices have continued to experience claims denials for these services in January. The NCMS again contacted Palmetto GBA and learned that corrective action had not been taken. Palmetto has now assured the NCMS that the erroneous edit has been turned off, and once testing is completed, mass adjustments will be begin this week. The adjustments should cover all affected claims going back to December. This will eliminate any additional paperwork on the part of practices to get the claims paid.

Please contact the NCMS Member Resource Center at [email protected] or 800-722-1350, if your practice continues to experience problems associated with this issue. The NCMS will continue to watch this situation closely and provide necessary updates in the Bulletin and at https://www.compassionatecarenc.org/.