Reprocessing Medicare Claims Affected by ACA/2010 Medicare Physician Fee Schedule Changes
CMS recently provided instructions to Medicare providers affected by retroactive provisions of the ACA and corrections to the 2010 Medicare physician fee schedule. Contractors will begin reprocessing a large volume of Medicare fee-for-service claims in the coming weeks. While the provider’s Medicare contractor will automatically reprocess most claims, any claims with submitted charges lower than the revised 2010 fee schedule amounts cannot be automatically reprocessed at the higher rates. In such cases, providers must request a manual reopening/adjustment from their Medicare contractor. CMS provides additional details on the reprocessing procedure, along with a discussion of HHS Office of Inspector General (OIG) policy related to waiving beneficiary cost-sharing amounts attributable to retroactive increases in payment rates.
