RCPA - Rehabilitation and Community Providers Association


Medicare Update
February 26, 2011

CMS Reprocessing Certain Claims
The Centers for Medicare and Medicaid Services (CMS) is reprocessing certain claims affected by implementation of the Affordable Care Act and changes to the 2010 Medicare Physician Fee Schedule. In most cases claims will be reprocessed automatically. Claims should not be resubmitted as they would be denied as duplicate claims, unless the claim contains services with charges lower than the revised 2010 fee schedule amount. These claims cannot be automatically reprocessed at the higher rate. Instead, a request for manual reopening/adjustment must be made to the Medicare contractor. CMS will extend the one-year time limit for reopening claims as needed. CMS reminds providers of the Office of the Inspector General (OIG) policy regarding waiving the cost sharing amount attributed to retroactive increases in payment rates resulting from new federal requirements available on the OIG web page.  More information is available on the Highmark Medicare Services, Provider Bulletins web page.

Preparation for HIPAA 5010
CMS encourages all HIPAA-covered entities that submit transactions electronically to begin testing version 5010 transaction standards as soon as possible. According to the CMS timeline, external testing of 5010 should have begun January 1. By January 1, 2012 all electronic claims must use 5010; version 4010 claims will no longer be accepted. By October 1, 2013 ICD-10 codes must be used for medical diagnoses and inpatient procedures. More information is available on the CMS web page.

Revision to MLN Matters on Smoking and Tobacco-Use Cessation Counseling
CMS has revised MLN Matters 3834, Smoking and Tobacco-Use Cessation Counseling originally issued May 2005 to include reference to MLN Matters 5878, which includes information about replacement codes for the temporary G codes used in the original version. MLN Matters 5878 is also available online. This is a consolidation of previously issued information.

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