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CR9968 CURES Act Fee Schedule Adjustments

Summary

CMS has issued Change Request (CR) 9968 This link takes you to an external website. and related contractor instructions to begin mass adjustments for all claims impacted by the extension of the transition to the fully adjusted Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) payment rates under Section 16007 of the 21st Century Cures Act.

Noridian will conduct mass adjustments to all claims covered under the rule and will be initiating adjustments on 06/26/17 for 36,000 claims each day for Jurisdiction D for the next 24 weeks as directed by CMS.

Mass Adjustments Update

Week 1 of 24 anticipated weeks

Noridian has completed 19.6 % of the claims adjustments as of 07/19/17.

We are aware of a small volume of claim adjustments resulting in an overpayment that could have been previously refunded. We are working with the Shared System Maintainer to best correct this problem.

Important Facts Regarding the Adjusted Claims

Noridian will conduct adjustments to the fee amounts for certain DME items furnished on or after January 1, 2016, in areas that are not competitive bid areas due to CR 9968 under the 21st Century Cures Act. Claim dates of services are July 1, 2016 – December 31, 2016 and mass adjustments will be conducted to correct claims payment.

There is no need for suppliers to call to see if their claims have been adjusted or when their claims will be adjusted. Noridian will be using  the CMS approved RARC Code ‘N689' to identify claim adjustments with the following Alert Message. Alert: This reversal is due to a retroactive rate change. N689 will be in the 2100.MOA segment of the ERA and in the claim header MIA/MOA section on the SPR.

There may be some claims adjusted that results in a potential overpayment. These may be due to patients in a SNF, HHH, etc. for the date of service on the claim. You will receive an overpayment demand letter.

Noridian will notify suppliers once the mass adjustment process is complete in a listserv and on the website.

Once the mass adjustment process is complete, suppliers can submit a request for reopening if the claim should have been processed with the KE modifier. Noridian recommends that requests to append the KE modifier to claims be identified and collectively sent to the Reopenings department via a special project. Additional instruction will be posted on how to submit the special project once the mass adjustments are completed.

No action is needed by suppliers at this time. A request for reopening to add the KE modifier to these claims will not be accepted at this time. As a reminder, the KE modifier cannot be appended to these claims until all claims in the mass adjustment have been completed.

Claim Processing Education

Suppliers should be aware of two claims processing items for the CR9968 Cures Act Fee Schedule Adjustments.

  1. Suppliers with oxygen claims covered under these mass adjustments may see miscellaneous code E1399cc on some remittances. Due to system limitations, the code E1399 is being used when previous oxygen CMNs have been deleted and are no longer on file due to a new CMN superseding the previous CMN. Code E1399 was used since it will not impact current or future oxygen claims. The cc modifier also signifies that the HCPCS was changed during processing.
     
  2. Noridian will not be adjusting rented Inexpensive and Routinely Purchased (IRP) items when the first rental month occurred before July 1, 2016. For rented IRP items, Medicare pays rentals up to the purchase price. Since the purchase price is established by the date of service from the first rental month, the purchase price will not change due to these adjustments, as the initial (first rental month) date of service does not fall into the timeframe for these adjustments, 7/1/2016-12/31/2016.

Frequently Asked Questions (FAQs)

Q1. Can I call the Contact Center to see if my claim will be adjusted?
A1. No, the customer service representatives will not be able to tell you which claims will be a part of the mass adjustment.

Q2. How will I know if my claim was adjusted?
A2. The remittance advice will identify these claims with RARC Code N689 - Alert: This reversal is due to a retroactive rate change.

Q3. Am I able to add the KE modifier once I receive my remittance advice showing the claim was adjusted to allow the new fee schedule?
A3. No, suppliers must wait to request the KE modifier to be added to claims once all claims have been adjusted in the mass adjustment. A listserv will be sent out when a special project reopening can be submitted as well as detailed instructions on how to submit.

Q4. Will my claims crossover to the secondary insurance?
A4. Crossover will occur if the supplemental insurer does not exclude adjusted claims from the crossover process. Please work with your supplemental insurers to determine if they accept adjusted claims.

Q5. How will I know the mass adjustments have been completed?
A5. Noridian will notify suppliers with listserv messages and notifications on the website.

Q6.  Will we get separate remittance advices for these CURES Act claim adjustments?
A6.  No, these adjustments are processing at the same time as new claims submitted to the DME MACs. 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 Medicare summary notices.

Q7.  Will my claims be expedited through the system?
A7.  No, these adjustments will be processed in Medicare's system against all online and common working file edits. This could include 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 these claims.

View CR9968 ACT Questions and Answers - June 28, 2017

Last Updated Jul 20, 2017