Breaking News: CMS Submits Change Request for Cures Act Adjustments

Posted on in Billing/Reimbursement

Thursday, CMS submitted a change request that outlines guidance to the DME MACs for the retroactive reimbursement of claims submitted by rural and non-bid providers for equipment and services furnished between July 1 and Dec. 31, 2016.

This request provides instructions regarding the implementation of section 16007 of the Cures Act signed into law December 2016. The change request can be viewed here.

“This change request appears to be the initial steps for DME MACs to create a process to adjust claims to the new fee schedule and conduct a mass reprocessing of these claims,” said Ronda Buhrmester, VGM reimbursement specialist. “Simply put, this means that providers will not be required to resubmit any new claims within the July-December 2016 timeframe.”

The request has an implementation date of July 3, 2017, but also notes that DME MACs can start reprocessing claims as soon as the revised fee schedules are loaded into their systems. The release also states that the DME MACs will be able to download the revised files “on or after May 1, 2017.”

Provider materials outlining these changes will soon be available on CMS’ website within the coming week.

“This release is welcomed news as providers will not be expected to take on the administrative burden to resubmit thousands and thousands of claims,” said John Gallagher, vice president of VGM Government Relations. “While this is a great win for providers, waiting until May 1 is far too long to wait to recoup those owed dollars.” Providers are encouraged to reach out to their members of Congress to ask that this revision date be moved up.

The fight still continues to make long-term reforms to the competitive bidding program to ensure patients maintain high access to quality care.

VGM will continue to publish any further information as it becomes available.