An update to the Centers for Medicare & Medicaid Services’ Outpatient Prospective Payment System (OPPS) has led to an error code that rejects claims to dialysis providers.
In a note to members earlier this week, the National Renal Administrators Association said CMS’ effort to implement an Oct. 1 update to the OPPS has resulted in an “incorrect rejection of dialysis claims (Bill type 72x)” which is impacting all dialysis providers. The NRAA says the claims can be identified in Medicare’s online system (DDE) or on Clearinghouse status reports as “Reason Code W7099 – Claim with pass-through or non-pass-through drug or biological lacks OPPS payable procedure (Return to Provider (RTP).”
The association said CMS is aware of the issue and is actively working to correct it. Medicare Administrator Contractors, which issue payments for CMS, are awaiting instruction from the agency on a fix and cannot release the claims until then. Providers are encouraged to contact the MAC for their region and report any rejected claims for reason code W7099.