February 24, 2015
Duplicate Paper Remittance Advices To Be Issued: “Net Zero” Adjustments
CGS recently initiated mass adjustments on certain claims because the patient responsibility amount did not match the calculated limiting charge limit when the Electronic Health Record (EHR) and the Physician Quality Reporting System (PQRS) reductions were applied. The patient responsibility amount was not being reported correctly on the remittance advices and/or patients’ Medicare Summary Notices (MSNs); however, the claims were pricing and paying correctly. These adjustments should not affect the providers' bookkeeping in any way, as these are "net zero" adjustments, meaning that no additional funds were paid and none are being recouped.
Claims associated with reductions for PQRS and/or EHR were processed with incorrect remark codes and are being adjusted to correct them. Because the claims were paid correctly, no changes were made to the payments. Initially, only a remark regarding the sequestration was included that included the word indemnification. Claims were adjusted to add additional remark codes to indicate the appropriate reduction in payment for PQRS and/or EHR.
As a result, duplicate remittance notices are being sent out for all impacted claims. These duplicate remittance advices will be sent on paper, even if the provider is set up to receive Electronic Remittance Advices (ERAs), and there will be one duplicate remittance advice per provider that will include all the impacted claims. The CHECK/EFT number displayed on the duplicate remittance will be a unique value generated for this purpose. (Normally, the CHEK/EFT value on the duplicate remittance reflects the internal check number for the remit being duplicated, but these duplicate remittance advices will have a value like 000000001 or 000000265.) This is one way CGS and providers can identify that the duplicate remittance advice was generated for this reason, as opposed to a "normal" duplicate SPR.

