CMS Begins Reprocessing Retroactive Payments

On Feb. 8, the Centers for Medicare and Medicaid Services (CMS) announced that it would begin reprocessing claims affected by the 2010 Affordable Care Act, including the 2% urban, 3% rural and 22.6% super rural bonus payments to ambulance providers, retroactive to Jan. 1, 2010. Medicare contractors didn’t begin reimbursing at the higher rates until July 2010, so claims for the entire first half of 2010 will need to be reprocessed.


“We expect that this reprocessing effort will take some time and will vary depending upon the claim-type, volume and each individual Medicare claims administration contractor,” CMS announced in a Feb. 8 e-mail bulletin. “In the majority of cases, you will not have to request adjustments because your Medicare claims administration contractor will automatically reprocess your claims. Please do not resubmit claims because they will be denied as duplicate claims and slow the retroactive adjustment process. However, any claim that contains services with submitted charges lower than the revised 2010 fee schedule amount (MPFS and ambulance fee schedule) cannot be automatically reprocessed at the higher rates. In such cases, you will need to request a manual reopening/adjustment from your Medicare contractor.”


Due to the circumstances, CMS is extending the usual one-year time limit for providers to request the reopening of claims.

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