1. Anonymous
   
   Posted 1 year ago #
   

   My favorite lines iin the conversion factor change transmittals are:
   Claims containing June dates of service that were submitted with charges greater than or equal to the new 2.2 percent update rates will be automatically reprocessed. Affected physicians/providers who submitted claims containing June dates of service with charges less than the 2.2 percent update amount will need to contact their local Medicare contractor to request an adjustment.
   Submitted charges on claims cannot be altered without a request from the physician/provider.
   How’s that automatic?

2. Melanie Cramer
   Member
   Posted 1 year ago #
   

   "Claims containing June dates of service that were submitted with charges greater than or equal to the new 2.2 percent update rates will be automatically reprocessed."

   Basically what Medicare does (something similar happened when I worked for Medicare) - they will do what they call a "Global Reprocess" - in this situation, they will query all claims by DOS' in the month of June with the greater/equal to the new 2.2% update rates, Medicare is automatically reprocessing those claims. In reality - it will probably be a two to three week basis, give or take. If you dont see anything within the first 30 days, you will need to call in.

   For the section that reads "Affected physicians/providers who submitted claims containing June dates of service with charges less than the 2.2 percent update amount will need to contact their local Medicare contractor to request an adjustment." - basically, this is viewed as a clerical error on the claims, and therefore Medicare cannot do an automatic reprocess without expressed verbal permission from the facility/provider to have them reprocessed. A representative from Telephone Reopening should be able to tell you over the phone whether or not you can handle this with them directly.

   A Global Reprocessing action is definitely not an across-the-board definition of the same action... Why the overage is getting a global reprocess and not the lower? In my humbled opinion, I sit back and ask - "Whats the difference"?

   Medicare is about as crooked as my husband's sense of humor... and THATS hard to beat!

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