Reprocessing Targeted Medicare Claims for Portions of 2010

New legislation and recent corrections to the 2010 Medicare Physician Fee Schedule (MPFS) call for reprocessing of a large volume of Medicare fee-for-service claims. Given this large workload, the Centers for Medicare & Medicaid Services (CMS) is taking steps to ensure that new claims coming into the Medicare program are processed timely and accurately, even as the retroactive adjustments are being made. CMS will begin to reprocess these claims over the next several weeks. This reprocessing effort is expected to take some time and will vary depending upon claim-type, volume and each individual Medicare claims administration contractor. Below is additional information to assist with any questions you may have:

How might this affect my fee-for-service claims payments?

1. This reprocessing of claims is NOT expected to impact the timeliness and accuracy of new claims being processed, even as the retroactive adjustments are being made.

2. This reprocessing of claims from the affected time period will begin over the next few weeks. The amount of time necessary to reprocess the claims will depend on many factors ( e.g., claim-type, volume, each Medicare contractor.)

3. In the majority of cases, you will not have to request readjustments; the Medicare claims administration contractor will automatically reprocess your claims.

What should I do?

1. DO NOT resubmit claims related to the reprocessing initiative. They will be denied as duplicate.

2. Any claims that contain services with submitted charges LOWER than the revised 2010 fee schedule amount (MPFS and ambulance fee schedule) CANNOT be automatically reprocessed at the higher rates. If you are due money as a result of the Affordable Care Act or corrections to the MPFS, you will need to request a manual reopening/adjustment from you Medicare contractor.

3. The normal one-year time limit for physicians and other providers and suppliers to request the reopening of a claim does not apply to these claims affected in the reprocessing. CMS is extending the time period to request adjustment of these claims, as necessary.

To obtain more information concerning this complex reprocessing of affected claims, please contact your individual Medicare claims administration contractor.

SPECIAL NOTE: The policy of the Office of Inspector General policy related to waiving beneficiary cost-sharing amounts attributable to retroactive increases in payment rates resulting from the operation of new Federal statutes or regulations may be found online.

2011-02-10T00:00:00+00:00 February 10th, 2011|Clinical Resources|