Noridian Incorrectly Denied Tens of Thousands of E&M Services Claims

 

Dear CPMA Members:

You may have been getting recent denials for E/M services with the denial code CO-151. Last fall during the transition from Palmetto to Nordian CMS (Centers for Medicare and Medicaid Services) experienced editing glitches with the new patient E&M codes that resulted in claims being inappropriately denied. The problems began in October of 2013 and were thought to have been corrected in early February 2014. CPMA, however, has learned that the same claims continued to be incorrectly paid through July 15, 2014.

In January, Noridian, California's Medicare contractor began making mass adjustments and correcting claims subjected to overpayment recovery. Unfortunately, in the process of implementing the corrections, Noridian inadvertently subjected established patient E&M codes to incorrect editing, resulting in incorrect denial of codes 99211- 99215.

Noridian has corrected the editing for both the new patient codes and the established patient codes, and claims received by Noridian on and after July 16, 2014, should be processing correctly. Noridian is now beginning the process of mass adjustments to the incorrectly denied claims. Due to the large number of claims involved (tens of thousands dating back to October of 2013), this process could take several months to complete.

Doctors do not need to do anything to have their claims adjusted and they should NOT resubmit the claims. The claims will be automatically adjusted.

Tony Poggio, DPM
Chair, Medicare Committee