Health Information Management

Pay-per-view: MACs to reprocess radiosurgery claims due to copayment miscalculation

APCs Insider, October 24, 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).
 
"This is quite different from normal practice," says Dave Fee, MBA, product marketing manager at 3M Health Information Systems in Murray, Utah. "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 make reimbursements."
 
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, but should have been set to the minimum unadjusted copayment equivalent to a coinsurance of 20%.
 
Continue reading “MACs to reprocess radiosurgery claims due to copayment miscalculation” on HCPro’s website. Subscribers to Briefings on APCs have free access to this article in the October issue.

 



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