CMS to Reprocess 2010 Medicare Claims

The Centers for Medicare & Medicaid Services (CMS) says many physicians' claims filed under the 2010 Medicare physician fee schedule will be reprocessed because the fees were affected by the retroactive dates of some of the provisions of the health system reform law passed last year. President Obama signed the Affordable Care Act (ACA) in March 2010, but some of the changes to the fee schedule were retroactive to January 2010.

CMS says it is "taking steps to ensure that new claims coming into the Medicare program are processed timely and accurately, even as the retroactive adjustments are being made. 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."

The CMS statement added that in most cases, "you will not have to request adjustments because your Medicare claims administration contractor will automatically reprocess your claims."

The Texas Medical Association's Payment Advocacy Department says physicians should note that:

  • Physicians should not resubmit claims.
  • Claims should be reprocessed automatically as long as the original billed charge wasn't lower than the corrected Medicare allowable amount.
  • If their billed charge was lower than the corrected Medicare allowable, physicians must request that the claim be reopened.
  • If physicians were overpaid, they will receive an overpayment refund request from TrailBlazer Health Enterprises, the Texas Medicare administrative contractor.
  • CMS reminds physicians of the Office of Inspector General policy on the routine waiver of patients' cost-sharing amounts when federal laws or regulations change.

Contact TrailBlazer if you need additional information.


Action, Feb. 15, 2011


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