AAA Releases Information Regarding Claims Processing for January and February 2003

AAA releases information regarding Claims Processing for January and February 2003. CMS distributed a Program Memorandum this week to its Carriers providing guidance on the automatic adjustments that carriers will have to do in July 2003 to pay additional amounts on claims with dates of service Jan 1 - Feb 28, 2003 that were processed after March 1, 2003, but should have received a higher rate per the 2002 Medicare Physician Fee Schedule. See
https://www.cms.hhs.gov/manuals/pm_trans/B03011.pdf

Audiologists are encouraged to submit all January and February claims by February 26 to ensure these are processed at the 2002 Fee Schedule Rates. All claims processed on March 1 (pending legislative action) will be processed using the 2003 rates. However, in July, CMS plans to adjust payments for those claims for Jan/Feb that were processed after March 1 and adjust the payment to the 2002 rate. Therefore, health care providers may be sent an additional check for this adjustment or be asked to pay back if there was an overpayment based on the difference of the 2002/2003 rates.

For additional information on carrier claims processing, see the CMS Instructions to Carriers at https://cms.hhs.gov/manuals/pm_trans/AB02181.pdf. This process resulted in the delay of publishing the 2003 Medicare Physician Fee Schedule which goes into effect March 1, 2003.

Billing of Audiologic Function Tests in Skilled Nursing Facilities (SNF) CMS announced this week that it has fixed an error in the system that resulted in denials for audiologic function tests for SNF residents during their Medicare Part B stay. Instructions will be sent to Fiscal Intermediaries in the next week to inform them of the systems corrections and how to re-process claims. The system is corrected as of Wednesday so future claims should not be denied. Any claims for past denials will have to be resubmitted to the carrier or fiscal intermediaries however; CMS has suggested that audiologists wait a week or so before resubmitting claims to allow the contractors to receive processing instructions from CMS. Audiologic function tests furnished to SNF residents will continue to be billed based on the requirements included in CMS Program Memorandum AB-02-038 (https://cms.hhs.gov/manuals/pm_trans/AB02038.pdf). Academy members brought this concern to The Academy and the issue was raised at recent CMS Open Door Forums in an effort to remedy the situation.