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07/13/2010

The Latest on the Medicare Physicians Fee Schedule

While the bill has been passed and the Medicare Physician Fee Schedule 2.2% increase is in effect, there is still confusion regarding what to do now to get the extra money from the increase.  The 2.2% increase is only effective from June 1.  Most claims have been paid at the new higher rate.  Some few were processed with the 21.5% cut.  Doctors have reported to me that they are being paid at the higher rate even though the new fee schedule is not listed on the carrier or MAC websites.

 First of all, do not re-submit the claims.  When you re-submit a claim that has already been billed, Medicare considers that to be double billing.  Double billing is a fraudulent act according to Medicare and the OIG.  Medicare Fraud carries heavy fines and possible jail time so don’t re-submit the claims.

 You should do a re-opening to change the billed amount to match the current fee schedule.  Usually, re-openings are conducted over the phone and many carriers limit you to three claims per call.  The following carriers and MACs have re-opening forms.

Cahaba  The re-opening form is located at https://www.cahabagba.com/part_b/forms/cerform.pdf.  You can list as many claims as you wish on one form as long as they all relate to a single error type.  You should note, “see attached” on the form and attach copies of all of the remittance advisories that you want corrected.  You should circle each patient and date of service that you want corrected on each RA.

 Trailblazer   The re-opening form is located at; http://www.trailblazerhealth.com/Publications/PDF%20Form/PartBReopeningRequestForm.pdf.