CMS issues instructions to Medicare Contractors to reprocess claims affected by The Affordable Care Act And 2010 Medicare Physician Fee Schedule Changes

On March 23, 2010, President Obama signed into law the Affordable Care Act. Various provisions of the new law were effective April 1, 2010, or earlier and, therefore, were implemented some time after their effective date. In addition, corrections to the 2010 Medicare Physician Fee Schedule (MPFS) were implemented at the same time as the Affordable Care Act revisions to the MPFS, with an effective date retroactive to January 1, 2010. Due to the retroactive effective dates of these provisions and the MPFS corrections, a large volume of Medicare fee-for-service claims will be reprocessed. Given this large workload, the Centers for Medicare & Medicaid Services 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. CMS expects that this reprocessing effort will take some time and will vary depending upon the claim-type, the volume, and each individual Medicare claims administration contractor. In the majority of cases, Medicare providers will not have to request adjustments because your local Medicare claims administration contractor will automatically reprocess your claims. Please do not resubmit claims because they will be denied as duplicate claims and slow the retroactive adjustment process. However, any claim that contains 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. Medicare providers will need to request a manual reopening/adjustment from your Medicare contractor. Reopenings are usually handled via telephone, through the Contractor’s Provider Contact Center. Check with your local Medicare contractor on how they will handle these reopenings/adjustments. Normally, physicians, other providers and suppliers have one year to request reopening of claims. CMS believes that these circumstances fall under the “good cause” criteria and has extended the time period to request adjustment of these claims, as necessary.


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