Corporate Compliance

Other developments: CMS announces reprocessing plan, introduces esMD, and more

Medicare Update for Physician Services, March 3, 2011

CMS posts second issue of provider compliance newsletter

CMS has issued its second edition of its provider compliance newsletter. This issue features discussions of excisional debridement, E/M services during a global surgery period, and more.

View the latest issue.

CMS announces re-processing plan

CMS has released a re-processing plan for physician claims affected by the Patient Protection and Affordable Care Act and 2010 MPFS changes. CMS will begin to reprocess these claims over the next several weeks, and expects 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. CMS’ announcement states:

In the majority of cases, you will not have to request adjustments because your Medicare claims administration contractor will automatically reprocess your claims. Please do not resubmit claims because they will be denied as duplicate claims and slow the retroactive adjustment process. However, any claim that contains services with submitted charges lower than the revised 2010 fee schedule amount (MPFS and ambulance fee schedule) cannot be automatically reprocessed at the higher rates. In such cases, you will need to request a manual reopening/adjustment from your Medicare contractor. While there is normally a one-year time limit for physicians and other providers and suppliers to request the reopening of claims, we believe that these circumstances fall under the “good cause” criteria described in the Claims Processing Manual, Publication 100-04, Chapter 34, Section 10.11 (http://www.cms.gov/manuals/downloads/clm104c34.pdf ). CMS is, therefore, extending the time period to request adjustment of these claims, as necessary.

CMS takes steps to allow providers to submit medical documentation electronically

CMS has posted information on its site regarding esMD pilot, or Electronic Submission of Medical Documentation (esMD) pilot, a new initiative that would allow providers to submit medical record documentation electronically to external auditors (e.g., RACs, CERT).

View the esMD web page.

Read esMD FAQs.

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