Modify Edits in the FFS System when a Beneficiary has a Medicare Advantage (MA) Plan - Revised

MLN Matters Number: MM11580 Revised
Related CR Release Date: July 21, 2020
Related CR Transmittal Number: R10229CP
Related Change Request (CR) Number: 11580
Effective Date: Claims received on or after October 1, 2020
Implementation Date: October 5, 2020

Note: We revised this article to reflect a revised CR 11850, issued on July 21, 2020. In the article, CMS revised the CR release date, transmittal number, and the web address of the CR. All other information remains the same.

CR 11580 modifies Medicare system edits on inpatient claims when a beneficiary’s MA plan becomes effective during the inpatient admission. Also, the Centers for Medicare & Medicaid Services (CMS) is streamlining the editing for MA plans’ claims when it is determined that certain services are being disallowed on MA plans that are considered a significant cost under Section 422.109(a)(2) of title 42 of the Code of Federal Regulations (CFR). Original Fee- For-Service (FFS) Medicare will pay for services obtained by beneficiaries enrolled in MA plans in this circumstance.

View the complete CMS Medicare Learning Network (MLN) Matters (MM)11580.


            Last Updated Thu, 23 Jul 2020 15:25:55 +0000