CMS to Begin Processing Claims Owed by Medicare

February 17, 2011

After coming under pressure from more than 100 physicians groups, the Centers for Medicare & Medicaid Services said it will reprocess a large number of Medicare claims to make up for retroactive payment increases that went into effect in 2010.

After coming under pressure from more than 100 physicians groups, the Centers for Medicare & Medicaid Services (CMS) said it will reprocess a large number of Medicare claims to make up for retroactive payment increases that went into effect in 2010, according to a report in AAFP News.

The Medicare and Medicaid Extenders Act of 2010 included $200 million to enable CMS to process the retroactive pay increases back to Jan. 1, 2010. Within days, more than 100 physicians groups signed a letter asking the federal government to quickly detail how it intended to pay out $200 million set aside in recent legislation for overdue Medicare reimbursements. The payments stem from several provisions in the Affordable Care Act, as well as certain corrections in the final 2010 physician fee schedule rule, the letter stated.

The doctors groups called the delay in reimbursements “highly disruptive,” and detailed the fallout medical practices have suffered as a result. “Many practices were forced to seek loans to meet payroll expenses, lay off staff or cancel capital improvements and investments in electronic health records and other technology,” the letter stated.

One specific underpayment cited involved cardiology codes. “The final 2010 fee schedule rule undervalued a number of cardiology codes due to errors in the CMS’s calculation of the practice expenses associated with myocardial perfusion imaging and professional liability insurance expenses for a number of high risk procedures, i.e. neurosurgery and cardiovascular,” the letter said.

On Feb. 8, CMS sent an electronic message to physicians and other Medicare providers saying the agency would ensure that healthcare providers received full payment on retroactive claims, quickly and accurately, AAFP News reported.

According to AAFP News, the message stated: "CMS will begin to reprocess these claims over the next several weeks. We expect that this reprocessing effort will take some time and will vary depending upon the claim type, the volume and each individual Medicare claims administration contractor."

CMS also noted that any retroactive amounts due would be included in a physician's next regularly scheduled remittance after the adjustment is made, AAFP News said.

For more information about the payments, and advice on how to proceed, click here.