According to guidance issued today by Centers for Medicare & Medicaid Services (CMS), suppliers will not require resubmitting claims to get retroactive payment adjustments mandated by the 21st Century Cures Act.
The Cures Act, signed into law in the month of December, rolled back cuts that went into effect in non-competitive bidding places from the day of June 30, 2016, to Dec. 31, 2016, permitting providers in those areas to recoup 6 months worth of payments.
In guidance issued to the DME MACs, CMS claimed that it’ll recalculate the fee schedule to extend the 50/50 blended fee schedule in effect from the time period of Jan. 1 to June 1, 2016, timeframe to the July 1 to Dec. 31, 2016, timeframe, in accordance to a bulletin from AAHomecare.
On or after May 1, 2017, the revised fee schedule will be available to the DME MACs. The DME MACs can begin processing affected claims as soon as the revised schedule–anticipated to be available May 1—is loaded into their systems.
There is no need for suppliers to submit new claims or other materials. Rather, a one-time process will be developed by DME MACs to validate and adjust claims, and will automatically conduct a mass reprocessing of claims. Suppliers who consider that their claims were not reprocessed will then require submitting a request.
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