Medicare Compliance & Reimbursement - 2011 Issue 14
Part B Payments: Reprocessed Claims From Last Year Are Headed Your Way Soon, CMS Reps Say
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Article Overview
This article summarizes guidance from a CMS Open Door Forum on Medicare Part B payment adjustments and related billing questions. It covers the reprocessing of previously paid claims affected by 2010 payment changes, uncertainty around who may perform annual wellness visits, handling of improperly collected copayments for those visits, and how primary care incentive payments may be identified. The content is aimed at practices, billers, coders, and revenue cycle staff who follow CMS operational updates and Medicare payment administration.
Why This Topic Matters
Providers and billing teams need to know when older claims may be adjusted, how Medicare expects incorrect patient cost-sharing to be handled, and where CMS guidance remains unclear. The article also highlights payment-remittance details that can affect reconciliation and practice accounting.
Article Sections
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Reprocessed Claims From Last Year
Discussion of Medicare Part B claim reprocessing related to earlier payment corrections and how the adjustments are being handled operationally.
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Who Can Perform AWV?
CMS commentary on staffing questions tied to annual wellness visits and the need for written guidance before relying on a specific interpretation.
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You Must Pay Your MAC Back for Incorrectly Collected Copays
Explanation of the issue involving beneficiary cost-sharing that was collected in error and the expected refund process through Medicare contractors.
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Primary Care Incentive Payments Will Be Identified
Information on how certain Medicare payment amounts may be distinguished on incoming checks and remittance records.
What You Will Learn
- How CMS is handling reprocessing of older Medicare Part B claims
- What operational questions remain about annual wellness visit staffing
- How CMS is addressing incorrectly collected beneficiary cost-sharing for wellness visits
- How primary care incentive payments may be labeled in payment processing
- Which Medicare administrative systems are involved in the adjustments and refunds
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle managers
- Practice administrators
- Primary care practices
- Medicare providers
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