Outpatient Facility Coding Alert - 2013 Issue 18
Sequester Cuts: Medicare Advantage Taking A 2 Percent Bite? Bite Back
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Article Overview
This article covers CMS’s guidance to Medicare Advantage organizations on sequestration-related payment reductions and the distinction between contracted and non-contracted provider arrangements. It is relevant to billing and reimbursement staff, practice managers, and compliance teams who work with Medicare Advantage claims and contract language. The piece focuses on the general policy issue, why practices may need to review payer contracts, and when claim reductions may warrant an appeal.
Why This Topic Matters
It helps providers understand whether Medicare Advantage payment reductions are appropriate under their contract terms and when to review or challenge reduced payments.
What You Will Learn
- How CMS addressed Medicare Advantage payment reductions tied to sequestration
- Why contracted and non-contracted provider status matters for Medicare Advantage reimbursement
- What to review in payer agreements when payments are reduced
- When a claim reduction may need to be appealed to the payer
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Revenue cycle staff
- Compliance professionals
- Physician offices
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