decisionhealth Newsletters, Part B News - 2011 Issue 2 (February)
CMS ready to reprocess, pay your 2010 claims reimbursed under old rates
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Article Overview
This piece covers CMS’s plan to reprocess certain 2010 Medicare claims that were paid under older fee schedule rates after changes tied to the Patient Protection and Affordable Care Act of 2010. It is relevant to physician practices, billing staff, and Medicare billers who need to understand the broad scope of the retroactive updates, the handling of patient copay and deductible amounts, and the possibility of repayment requests for some claims.
Why This Topic Matters
Retroactive fee schedule changes can affect payment accuracy, patient balances, and whether practices need to reopen or adjust claims. The article helps readers anticipate administrative follow-up without reissuing claims or mistaking the reprocessing process for routine billing.
What You Will Learn
- The scope of CMS’s retroactive reprocessing of affected 2010 claims
- Which types of fee schedule changes prompted the reprocessing
- How patient cost-sharing waivers relate to the retroactive payment changes
- What practices may need to do if claims were not automatically adjusted
- Why some claims may generate overpayment requests
Who Should Read This
- Physician practices
- Medical billers
- Coding professionals
- Revenue cycle staff
- Medicare billing staff
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