Due to changes that have gone into effect, including the Affordable Care Act revisions to the 2010 Medicare physician fee schedule and corrections to the MPFS, a large number of Medicare fee-for-service claims will undergo reprocessing to readjust inaccurate payments, according to a letter from CMS.
CMS has stated that it will begin to reprocess the already submitted claims in the following weeks, and the necessary steps will be taken to ensure new claims are processed in a timely and accurate manner. CMS is alerting physicians that they do not need to request adjustments since Medicare claims administration contractors will automatically reprocess the appropriate claims. Physicians should also not resubmit claims, as they will be denied as duplicate claims and deter the adjustment process.
Any claims with charges that are lower than the revised 2010 fee schedule must be handled by a Medicare contractor, who will conduct a manual reopening/adjustment. CMS is extending the time frame in which physicians can request the reopening of claims to more than one year.
After a Medicare claims administration contractor has reprocessed a claim, any underpayments will be included in the next regularly scheduled remittance. Medicare claims administration contractors will request repayment for any overpayments resulting from physicians' claims. If overpayment is less than $10, contractors will not request repayment until the total amount owed amounts to at least $10.
Read the letter about Medicare claims reprocessing.
Read other coverage about ASC coding, billing and collections:
- One-Third of Healthcare Providers Not Ready for 5010
- 5 Best Practices for Ensuring Full Payment From Patients
- AAPC Column Outlines Objectives for ICD-10 Preparation 1,000 Days From Implementation Date
CMS has stated that it will begin to reprocess the already submitted claims in the following weeks, and the necessary steps will be taken to ensure new claims are processed in a timely and accurate manner. CMS is alerting physicians that they do not need to request adjustments since Medicare claims administration contractors will automatically reprocess the appropriate claims. Physicians should also not resubmit claims, as they will be denied as duplicate claims and deter the adjustment process.
Any claims with charges that are lower than the revised 2010 fee schedule must be handled by a Medicare contractor, who will conduct a manual reopening/adjustment. CMS is extending the time frame in which physicians can request the reopening of claims to more than one year.
After a Medicare claims administration contractor has reprocessed a claim, any underpayments will be included in the next regularly scheduled remittance. Medicare claims administration contractors will request repayment for any overpayments resulting from physicians' claims. If overpayment is less than $10, contractors will not request repayment until the total amount owed amounts to at least $10.
Read the letter about Medicare claims reprocessing.
Read other coverage about ASC coding, billing and collections:
- One-Third of Healthcare Providers Not Ready for 5010
- 5 Best Practices for Ensuring Full Payment From Patients
- AAPC Column Outlines Objectives for ICD-10 Preparation 1,000 Days From Implementation Date