CGS begins payment adjustments

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Wednesday, May 10, 2017

WASHINGTON – CGS will begin adjusting tens of thousands of claims from non-competitive bidding areas each day for about the next 24 weeks, the DME MAC for Jurisdictions B and C announced May 8.

The adjustments come in response to a provision in the 21st Century Cures Act that requires CMS to retroactively delay a second round of reimbursement cuts in non-bid areas from July 1, 2016, to Jan. 1, 2017, allowing HME providers to recoup six months of payments.

CGS says it will begin adjusting about 40,000 claims each day in Jurisdiction C and about 20,000 claims each day in Jurisdiction B. The claims will be “mass adjusted.”

The full implementation date for the adjustments is not until July 3.

While plans for the “mass adjustment” come as a relief, industry stakeholders take issue with what The VGM Group calls the “long delay in payment.”

Stakeholders also take issue with the adjusted amounts, which are based on the July 1, 2016, fee schedule instead of the Jan. 1, 2016, fee schedule. The latter, they say, is what Congress intended.