Delayed fee schedule could mean you owe money to Medicare

Why This Topic Matters

Delayed claims processing and retroactive status changes can affect whether practices receive additional payment, face repayment requests, or need to track later adjustments. The article also notes timing concerns around therapy cap implementation that may matter to practices furnishing Part B services.

Article Sections

1. Fee schedule transition and claim processing timing

   Overview of how delayed processing under the new fee schedule can affect payment timing for services provided before the effective date. The section focuses on CMS administration of payment adjustments and related repayment activity.

2. Lump sum repayments

   Discussion of how CMS described the handling of later adjustments when claims are reprocessed. It also addresses possible batch payments and interest on underpayments.

3. A switch to non-par status could have complications

   Summary of the timing issue created by participation-status changes and the retroactive effective date CMS planned to use. The section also references how CMS would handle potential reversals if Congress altered the scheduled fee schedule cut.

4. Physical and occupational therapy caps

   Coverage of CMS’s expected timeline for implementing therapy caps and the general manner in which the cap was expected to be applied. The section notes the affected setting and the fact that CMS planned to provide additional implementation details in writing.

5. How your claims will be paid for January and February services

   A summary table that compares several claim-processing scenarios and the resulting payment outcomes. It presents timing-based examples of how CMS expected the adjustments to work.