Cures adjustments require planning

‘This is not a Publishers Clearing House prize, where they show up at the door and give you a cardboard check’
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Friday, June 30, 2017

YARMOUTH, Maine – Sure, getting the money they’re owed will be great, but are HME providers ready to process adjusted claims?

“There are, surprisingly, a lot of internal process considerations,” said Andrea Stark, a reimbursement consultant for MiraVista. “These are going to be some of the more complex claims in your system.”

N689, a recently announced remark code that will allow providers to identify adjustments will help, but other process considerations include how providers handle other payers and patient co-pays.

Other payers

“In North Carolina, for example, Medicaid has an allowable that was above the July 1 rates, but now they’re below the Cures adjusted rate—that will result in Medicaid recoveries,” Stark said. “Now Medicaid has overpaid for a couple of services. I don’t know how materially that will be felt, but these are the kind of scenarios providers have to figure out.”

Patient co-pays

“Do you go back to patients and ask for the portion of co-pays you’re owed?” Staked said. “There’s no right or wrong answer, but each has its consequences. If you pursue it, prepare to have confused and angry patients asking you, ‘Why are you collecting on this?’ You also have to ask yourself how much you’re going to spend trying to collect 20% of a 20% adjustment. But you are entitled to that money.”

Get out the ‘elbow grease’

Stark advised providers to take time in June and even July, before the DME MACs start processing adjustments on a daily basis, to put a plan in place.

“They need to make sure they’ve thought through all the angles,” she said. “This is not a Publishers Clearing House prize, where they show up at the door and give you a cardboard check. It’s going to take some elbow grease.”