The Centers for Medicare & Medicaid Services soon will begin reprocessing Medicare claims affected by retroactive provisions of the Patient Protection and Affordable Care Act and physician fee schedule legislation. These include claims for physicians, hospitals and other care providers affected by payment adjustments retroactive to Oct. 1, 2009, Jan. 1, 2010 and April 1, 2010.
Reprocessing likely will start with inpatient claims, which are expected to have the fewest affected claims, then outpatient claims followed by physician claims, the agency told the American Hospital Association. In most cases, the Medicare claims administration contractor will automatically reprocess a provider’s retroactive adjustments.
However, providers will need to request a manual reopening/adjustment from their Medicare contractor for any claims with submitted charges lower than the revised 2010 physician fee schedule amount. For more information, see the CMS notice.
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