Cures adjustments: Stakeholders secure remark code, await payments

YARMOUTH, Maine - HME stakeholders are cheering a hard-fought win for a remark code that will allow providers to identify when claims have been adjusted due to a retroactive delay to reimbursement cuts in non-competitive bidding areas.

The DME MACs agreed with the need for the code, found one that was appropriate and forwarded the request to CMS. But initially, they were told no, stakeholders say.

“There was push back, because of the additional programming time it might require,” said Kim Brummett, vice president of regulatory affairs for AAHomecare. “CMS said, 'We don't want to hold up the adjustments,' and we don't want to, either, but we need a code. The industry shared its concerns and, lo and behold, they were able to program the code.”

The adjustments are mandated by the 20^th Century Cures Act. A provision in the act delays a second round of reimbursement cuts in non-bid areas from July 1, 2016, to Jan. 1, 2017, allowing providers to recoup a portion of six months worth of payments.

The remark code—N689—will not only give providers a way to parse out Cures adjustments from other reprocessed claims, but also, theoretically, give software vendors a data point for creating customized reports, stakeholders say.

“That way providers know how many claims have been adjusted, how much money they've collected, and, just in general, how things are moving through,” said Andrea Stark, a reimbursement consultant for MiraVista, who hosted a webcast recently on how providers should be preparing for the adjustments.

Stakeholders breathed a sigh of relief when providers started receiving adjustments in May, but it turns out the MACs were just running two test batches. The MACs, which are still processing their normal load of claims, wanted to see how much additional work processing the adjustments will be, they say.

“They watched to see how many of them suspended for manual customer service intervention and will require people power,” Stark said. “They did notice some issues, including recoupments that were requested after an overpayment had already been paid, and recoupments that were initiated for skilled nursing facility visits where the data may have changed after the fact.”

While stakeholders have argued the adjustments are taking too long, they acknowledge it's a huge undertaking, with the MACs expected to process 140,000 claims per day across the four jurisdictions once they're running full bore in July.

“I think it's been a big issue for suppliers and the MACs, because of the volume and how it needs to be handled,” said Ronda Buhrmester, a reimbursement specialist for the VGM Group. “We're hoping once they work out some of the kinks it will go quicker.”