• Mass Rejection of Medicare Dialysis Claims Impacting September 2016 Claims

    Infian was made aware of CMS rejecting a lot of dialysis claims which more than likely impacts your September Medicare claims.   The message below was sent out by NRAA. CMS is trying to resolve this issue as soon as possible.   Please contact your Medicare Administrative Contractor (MAC) for further details.


    It has come to our attention that the recent CMS Outpatient Prospective Payment System (OPPS) update (CR9754) effective October 1, 2016, has resulted in the incorrect rejection of dialysis claims (Bill type 72x), which is affecting ALL DIALYSIS PROVIDERS.

    The claims can be identified in Medicare’s online system (DDE) or on Clearinghouse status reports with a Reason Code W7099 – Claim with pass-through or non-pass-through drug or biological lacks OPPS payable procedure (Return to Provider (RTP)).

    The MACs are awaiting instruction from CMS on a fix and cannot release the claims at this time.

    If you have claims rejected with reason code W7099 please contact the MAC for your facility informing them of the issue. This will help reinforce the magnitude of the issue.

    NRAA’s Legislative Counsel, Mehlman Castagnetti Rosen & Thomas, is contacting CMS to get this resolved as soon as possible.