Hold off on resubmitting claims affected by recent Medicare payment changes to the physician fee schedule. Some practices might be anxious to recoup money owed because of changes in its favor, but CMS says now is not the time.
The health care reform law forced CMS to make retroactive corrections to the fee schedule. As a result, the conversion factor used in the physician payment formula fell by half a cent. However, physicians in low cost areas will see payments rise because of positive geographic updates to the fee schedule.
The changes are taking some time to implement, but CMS is signaling it is closer to paying claims at the new rate. First, Medicare Administrative Contractors (MACs) will install new files to calculate reimbursements. CMS says MACs will then start paying new claims at the revised or corrected rate. CMS will later notify physicians and practices of how the agency plans to correct claims paid under old rates during the first half of the year.
It's not clear if CMS will require practices to resubmit claims. MACs might be able to make adjustments on their own. But resubmitting claims now will just produce a denial for submitting a duplicate claim, CMS says.