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July 06, 2010

Medicare Physicians Fee Schedule Increase - Should You Resubmit Claims?

While the bill has been passed and the Medicare Physician Fee Schedule 2.2% increase is in effect, there is still confusion regarding what to do now to get the extra money from the increase.  The 2.2% increase is only effective from June 1.  Most claims have been paid at the new higher rate.  Some few were processed with the 21.5% cut.  Doctors have reported to me that they are being paid at the higher rate even though the new fee schedule is not listed on the carrier or MAC websites.

First of all, do not re-submit the claims.  When you re-submit a claim that has already been billed, Medicare considers that to be double billing.  Double billing is a fraudulent act according to Medicare and the OIG.  Medicare Fraud carries heavy fines and possible jail time so don’t re-submit the claims.

You should do a re-opening to change the billed amount to match the current fee schedule.  Usually, re-openings are conducted over the phone and many carriers limit you to three claims per call.  The following carriers and MACs have re-opening forms.

Cahaba
The re-opening form is located at https://www.cahabagba.com/part_b/forms/cerform.pdf.  You can list as many claims as you wish on one form as long as they all relate to a single error type.  You should note, “see attached” on the form and attach copies of all of the remittance advisories that you want corrected.  You should circle each patient and date of service that you want corrected on each RA.

Trailblazer
The re-opening form is located at; http://www.trailblazerhealth.com/Publications/PDF%20Form/PartBReopeningRequestForm.pdf.
You must use one form per claim

First Coast
The re-opening form is located at; http://medicare.fcso.com/Forms/138074.pdf.  The form will list 10 change requests.  All related information (dates of service, ICN, etc.) must be completed on the form or the request will not be honored.  A new confirmation number must be obtained for each faxed clerical reopening request by calling Medicare Part B at (866) 454-9007 for Florida and the U.S. Virgin Islands or (877) 715-1921 for Puerto Rico.  A limit of 10 forms can be submitted per day.  You can fax the completed request to (904) 361-0384.

NHIC Corp.
The re-opening request form is located at; http://www.medicarenhic.com/ne_prov/forms/Reopening_Request_Form.pdf.  You can list as many claims as you wish on one form as long as they all relate to a single error type.  You should note, “see attached” on the form and attach copies of all of the remittance advisories that you want corrected.  You should circle each patient and date of service that you want corrected on each RA.

National Government Services
This MAC has no re-opening request form available on their website.  Re-openings are to be conducted by phone.

Noridian
The re-opening form is located at; https://www.noridianmedicare.com/p-medb/forms/docs/nas_reopen.pdf.  There is a limit of one form per request and beneficiary.  Follow the directions on the form.

Palmetto GBA
The re-opening form is located at; http://www.palmettogba.com/Palmetto/Providers.nsf/files/Redetermination-Reopening_Request_Form_(J1_MAC).pdf/$FIle/Redetermination-Reopening_Request_Form_(J1_MAC).pdf.  This is also the redetermination form so you must check the “This is a Reopening” check box.  You must use a different form for each beneficiary but you can put multiple dates of service on the form.

CIGNA
The re-opening form is located at; http://www.cignagovernmentservices.com/partb/forms/pdf/GEN_reopenings_adjust.pdf.  You must use a different form for each beneficiary but you can put multiple dates of service on the form.

Highmark
This MAC has no re-opening request form available on their website.  Re-openings are to be conducted by phone.

Pinnacle
This MAC has no re-opening request form available on their website.  Re-openings are to be conducted by phone.

WPS
The re-opening form is located at; http://www.wpsmedicare.com/part_b/business/reopening_request_form.pdf.  You can list as many claims as you wish on one form as long as they all relate to a single error type.  You should note, “see attached” on the form and attach copies of all of the remittance advisories that you want corrected.  You should circle each patient and date of service that you want corrected on each RA.
Due to the delay in establishing a fee schedule for this year, Medicare has extended the deadline to become a participating provider to July 16.  If you were waiting to see what the fee schedule would be, you still have a chance to become a Par provider.

Those of you that have waited until this point to submit claims, it is OK to do so now.

Dr. Ron Short, DC, MCS-P
Heartland Consulting Group
217-285-2300
drron1085@gmail.com


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