Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

CMS Puts Medicare Part B Claims on Two Week Hold

By Ryan Mcaskill

Because of an issue with the 2015 Medicare Physician Fee Schedule, CMS has put a temporary hold on claims while it’s fixed.

- Hospitals and other healthcare providers that submitted Medicare Part B claims at the start of the year may need to wait a little longer for reimbursement. This is because the Centers for Medicare and Medicaid Services has directed administrative contractors to put a hold on Medicare Part B claims for the first two weeks of 2015.

According to an announcement from CMS, On November 13, 2014, the Medicare Physician Fee Schedule (MPFS) for the calendar year 2015 was released. The MPFS includes a number of provisions and it turns out that one of them is incorrect.

While the exact issue that was discover was not released, but it is known that it involved Medicare Part B claims.

Medicare Part B covers a number of services and supplies that are considered medically necessary to treat a disease or condition or prevent one from getting worse when captured at an early stage. Some of these rules may be different for Medicare Advantage Plan or other Medicare plans, but it will have the same basic coverage as the original Medicare.

Areas that are covered by Medicare include:

•Clinical research

•Ambulance services

•Durable medical equipment

•Mental health – inpatient, outpatient and partial hospitalization

•Pre-surgery second opinion

•Limited outpatient prescription drugs

In order to implement corrections to technical errors that were discovered after the final rules were published, CMS instructed Medicare Administrative Contractors to hold claims containing 2015 services paid under the MPFS for the first 14 days of 2015. While this will have some organizations afraid, CMS reassured providers that there will be little to no impact on the reimbursement of these claims.

“The hold should have minimal impact on provider cash flow as, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt,” the CMS announcement reads.

This only applies to claims that were filed after December 31, 2014 and any filed on that day or before will not be affected by the hold order and will be processed during the regular time frame.



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