Healthcare payer organizations that use the Medicare fee schedule must begin reprocessing claims as of last week. Due to provisions in the Bipartisan Budget Act of 2018 that was passed on Feb. 9, CMS issued Change Request 10531 directing payers and Medicare Administrative Contractors (MACs) to reprocess FFS claims relating to Medicare Extenders (the Medicare FFS policies that were extended include Ambulance Add-On Payment provisions, the GPCI floor, and the 3% Home Health Rural Add-on Payment). Claims Processing Actions to Implement >>
This is actually a fairly common occurrence with CMS issuing updated Medicare fee schedules months after the fact. Claims with a date of service from Jan. 1 through Feb. 12, 2018, must be repriced and reprocessed, if the payer used the Medicare Fee schedule to reimburse their providers. This will result in a significant manual effort for payers that have no way to automatically adjust their claims retroactively. HCIM’s SymKey® robotic claims tool allows users to easily automate this process within their core claims transaction system. In fact, many SymKey® clients have used this functionality in years past to retroactively adjust Medicare FFS claims. Read how to reprocess previously paid claims with SymKey® >>
For more information on how to automate your manual claim actions, including repricing, reducing your backlog, and ensuring a quick turnaround, please complete the form on the sidebar. Current SymKey® users may contact HCIM Product Support at support@hcim.com for assistance in automating this process.
About SymKey®
SymKey® uses robotic automation to process healthcare claims more efficiently through programmed artificial intelligence. Anything that a claims examiner can do, SymKey® can do faster and with 100% accuracy, allowing your staff to focus on more complex tasks. Since it runs entirely through the frontend of your claims system just like any user would, your IT department can rest assured that everything is secure. Learn More >>