CMS releases guidance on bid-rate relief

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Thursday, February 9, 2017

WASHINGTON – Suppliers won’t need to resubmit claims to get retroactive payment adjustments mandated by the 21st Century Cures Act, according to guidance released today by CMS.

The Cures Act, signed into law in December, rolled back cuts that went into effect in non-competitive bidding areas from June 30, 2016, to Dec. 31, 2016, allowing providers in those areas to recoup six months worth of payments.

In guidance released to the DME MACs, CMS said it will recalculate the fee schedule to extend the 50/50 blended fee schedule in effect from Jan. 1 to June 1, 2016, timeframe to the July 1 to Dec. 31, 2016, timeframe, according to a bulletin from AAHomecare.

The revised fee schedule will be available to the DME MACs on or after May 1, 2017. The DME MACs can start processing affected claims as soon as the revised schedule–expected to be available May 1—is loaded into their systems.

Suppliers don’t need to submit new claims or other materials. Instead, the DME MACs will create a one-time process to validate and adjust claims, and will automatically perform a mass reprocessing of claims. Suppliers who believe that their claims weren’t reprocessed will then need to submit a request.