CMS Holding 2015 Medicare Claims Until January 14, 2015 CMS just announced that Medicare contractors will hold claims for services (including ambulance transports) paid under the 2015 Medicare Physician Fee Schedule (PFS) for the first 14 calendar days of January 2015 - i.e., January 1, 2015 through January 14, 2015. The hold was put into place to implement several corrections to errors that CMS discovered after it published the CY 2015 PFS Final Rule on November 13, 2014. This 2-week hold should have minimal impact on cash flow since, under current law, clean electronic claims arent paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt by CMS. Claims for services rendered on or before Wednesday, December 31, 2014 are not affected by the claims hold and 2014 claims will be processed and paid under normal procedures and time frames. The 2015 Medicare PFS Rule updates geographic areas, and many ZIP codes are changing from rural to urban and urban to rural in 2015. The changes are significant because ambulance transports originating in rural ZIP codes are paid at a higher rate than transports originating in urban ZIP codes. In addition, CMS revised the 2015 ambulance inflation factor up to 1.5% this past fall (click HERE to read PWWs summary and the transmittal). Make sure to check CMSs Ambulance Fee Schedule site and the CMS Ambulance Services Center for the latest ZIP code and public use files for 2015. Just as a reminder, whenever your Medicare Part B rates change, check your explanation of benefit (EOB) statements for payment errors and ensure that your non-contracted Medicare Advantage payments appropriately reflect the changes. Some patients also have to meet deductibles starting January 1 so be sure to plan accordingly and account for new healthcare reform plans.
Posted on: Wed, 31 Dec 2014 23:34:19 +0000