Health Information Management

Tip: Radiosurgery claims reprocessed due to copayment miscalculation

APCs Insider, October 3, 2014

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CMS has instructed MACs to reprocess claims and providers to reimburse beneficiaries due to a miscalculated copayment for stereotactic radiosurgery, according to the October update to the OPPS and Integrated Outpatient Code Editor (I/OCE).
 
Usually, when CMS makes payment changes, providers can reprocess claims if it's important to them. In this case, MACs will be reprocessing the claims, and hospitals will have to reimburse patients.
 
CMS originally miscalculated the national unadjusted copayment for APC 0066 (level I stereotactic radiosurgery) in the 2014 OPPS final rule. The amount was set to an explicit value instead of the minimum unadjusted copayment equivalent to a coinsurance of 20%. CMS corrected the copay amount in July in the OPPS update, but didn't make it retroactive.
 
The corrected amount has now been made retroactive to January 1, 2014, and MACs will be reprocessing claims from that date through June 30. MACs were scheduled to complete mass reprocessing these claims by September 1, according to CMS.
 
This tip is adapted from “MACs to reprocess radiosurgery claims due to copayment miscalculation” in the October issue of Briefings on APCs.



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