CMS Reprocessing Claims Affected by Affordable Care Act and 2010 Medicare Physician Fee Schedule Changes

CIGNA Government Services (CGS) has informed North Carolina Medicare physicians and other providers that CMS is reprocessing claims that were affected by retroactive provisions in the Affordable Care Act (ACA).  This includes corrections made to the Medicare Physician Fee Schedule (MPFS) as a result of retroactive effective dates.

In a memo dated February 9, 2010, CGS says a large volume of Medicare fee-for-service claims will be reprocessed. At the same time, CMS is taking steps to ensure that new claims are processed timely and accurately, while the retroactive adjustments are being made. CMS estimates the reprocessing will take some time and will vary depending on the claim-type, volume, and CIGNA Government Services.

CMS says in most cases Medicare providers will not have to request adjustments because their Medicare claims administration contractor will automatically reprocess the claims. CMS asks that providers 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 processed at the higher rates. In such cases, the provider will need to request a manual reopening/adjustment from CIGNA Government Services.

Click here for more information and to read the complete CMS/CIGNA Government Services announcement.


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