2020 Mass Adjustments for MPFS and Anti-markup Services

Provider/Supplier Type(s) Impacted: All CA providers paid under the Medicare Physician Fee Schedule (MPFS) and all non-CA providers paid under the Anti-Markup fees.

Reason Codes: Not applicable

Claim Coding Impact: Codes priced from the MPFS and CA Anti-Markup codes.

Description of Issue: The file related to the Further Consolidated Appropriations Act (FCAA) of 2020 had incorrect Geographic Practice Cost Indices (GPCIs) used to calculate fees for California resulting in overpayments.

Noridian Action Required: CMS has updated the MPFS file and Noridian has installed the files to production.

Provider/Supplier Action Required: No provider action is needed to correct the claims. Providers should follow the regular recoupment process for paying any overpayments resulting from the adjusted claims.

Proposed Resolution/Solution: Noridian will identify and reprocess claims that were processed prior to 01/20/20 and priced incorrectly. Adjustments are expected to be initiated in February.

02/06/20 - Noridian will start mass adjusting claims the week of 02/10/20.

Date Reported: 01/22/20

Date Resolved:

 

Last Updated Feb 06, 2020