CR9968 ACT Questions and Answers - June 28, 2017
Q1. What is the reference for these CURES Act adjustments?
A1. Section 16007 of the 21st Century CURES Act provided an avenue for a certain segment of DME claims (approximately eleven million total) to be adjusted. CMS gave instruction on handling these claims in MLN Matters article MM9968. Essentially, non-competitive bid claims with dates of service July 1, 2016, through December 31, 2016, will be adjusted using the fee schedule in place on January 1, 2016.
Q2. When will the claims be adjusted?
A2. The DME MACs are currently adjusting these claims. We anticipate the process will take approximately 24 weeks. We expect that a majority of claim adjustments will be processed to completion with minimal manual adjudication by the DME MAC staff.
Q3. Can I do anything so my specific claims will be adjusted first?
A3. CGS is working with the shared system maintainer to assure all impacted claims are identified. Suppliers should not contact their Provider Contact Center as the customer service representatives are unable to tell you when your claims will be adjusted or move your claims to the "front of the line."
Q4. How can I tell if my claims have been adjusted?
A4. CMS has given the DME MACs the authority to add a RARC code to the remittance advice statement. Suppliers should look for N689 on their remits. The associated message with N689 is "Alert: This reversal is due to a retroactive rate change." N689 will be in the 2100.MOA segment of the Electronic Remittance Advice and in the claim header MIA/MOA section on the printed remittance statement, known as the Standard Paper Remittance. All four DME MACs will use RARC code N689, so it is not specific to one jurisdiction.
Q5. Will we get separate remittance advices for these CURES Act claim adjustments?
A5. No, you will not. These adjustments are processing at the same time as the claims you submit as new claims to the DME MACs. As such, your remittance advice statements could include some CURES Act adjustments as well as claims you submitted over the past few weeks. It is important to review your remittance advice statements for claims that have the remark code N689 associated with them. Similarly, beneficiaries will see these CURES Act adjustments on their quarterly Medicare summary notices with other claims. As a reminder, beneficiaries can call 1-800-Medicare with any questions they have about their summary notices.
Q6. Will my claims be expedited through the system?
A6. No, they will not. These adjustments will be processed in Medicare's system against all online and common working file edits including inpatient stays in a skilled nursing facility, Medicare advantage plan enrollment, and home health episodes. It is possible that a claim could deny based on these edits. You will receive an overpayment demand letter for claims that deny when going through this process. It is also important to note that if there is a crossover agreement in place for adjusted claims; CGS will forward these claims to the appropriate health insurance carrier.
Q7. What if I have some claims that need the KE modifier added to them?
A7. Once the mass adjustment process is complete in approximately 24 weeks; suppliers should submit a request to reopen the claim if it should have been processed with the KE modifier. Noridian recommends that requests to append the KE modifier be submitted through the Noridian Medicare Portal or faxed to Written Reopenings. Complete the DME Reopening Request Form [PDF]. You may submit a spreadsheet if there are multiple claims involved, but you must include the following information:
- Provider Transaction Account number (PTAN)
- Medicare ID
- Name of the Beneficiary
- Date of Service
- Claim Control Number
- HCPCS code
- Must clearly state to add the KE modifier
Please do not include more than 250 claims per Reopening request.
Q8. Will Noridian provide any updates for us?
A8. Yes. Noridian will provide updates and pertinent information on our CR9968 CURES Act Fee Schedule Adjustments webpage.
Q9. How do we know what claims will need to have the KE modifier added?
A9. The KE modifier was added to the DMEPOS fee schedule file as part of the January 2009 fee schedule update and described items that were bid under the initial Round 1 CBP but were used with non-competitive bid base equipment. Suppliers should submit a request for reopening if their claim for dates of service between July 1, 2016, and December 31, 2016, should have been processed with the KE modifier.
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Last Updated Feb 23, 2018