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CMS Announcement - Holding of 2015 Date-of-Service Claims - MPFS

  • by Margaret Klasa DC, APN BC
  • Dec 30, 2014, 11:13 AM

While the Compliance Edge blog is typically reserved for original content authored by Margaret Klasa, DC, APN, Bc, at times, we will re-post industry news or announcements that are relevant to our customer base.

Context Medicare Announcement Holding of 2015 ClaimsHolding of 2015 Date-of-Service Claims for Services Paid Under the 2015 Medicare Physician Fee

Source: MLN Connects™ Provider e-News
Monday, December 29, 2014

On November 13, 2014, the CY 2015 Medicare Physician Fee Schedule (MPFS) final rule was published in the Federal Register. In order to implement corrections to technical errors discovered after publication of the MPFS rule and process claims correctly, Medicare Administrative Contractors will hold claims containing 2015 services paid under the MPFS for the first 14 calendar days of January 2015 (i.e., Thursday January 1 through Wednesday January 14). The hold should have minimal impact on provider cash flow as, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt.

MPFS claims for services rendered on or before Wednesday Dec 31, 2014 are unaffected by the 2015 claims hold and will be processed and paid under normal procedures and time frames.

Context Custom Physician Fee Reports

Which of my fees are too low? Which are too high? Which are priced about right? How much should I charge for new and revised codes? How much should I charge for services I have not previously billed? How much does Medicare allow under its current fee schedule? What data can help me with managed care negotiations, or payer network contracting? Resolve these issues with Context Physician Fee Reports.

Each custom report contain usual, customary, and reasonable medical fee schedules that are in accordance with the amounts charged by physicians in your ZIP Code area. Also, each report includes the current Medicare Fee Schedule. Each fee schedule provides charges from the 50th through the 95th percentile, which can  ensure that the fees you charge are benched marked with rates of your local peers.

Read more Compliance Edge blog posts:  New Anti-Fraud Safeguards Under ACA Impact Medicare Billing Privileges

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