Reingruber Alert: Reimbursement and Billing Updates for Medicare Providers

2/17/2022 - By Chris Biedal

Medicare FFS Claims: 2% Payment Adjustment (Sequestration) Changes

The Protecting Medicare and American Farmers from Sequester Cuts Act impacts payments for all Medicare Fee-for-Service (FFS) claims:

  • No payment adjustment through March 31, 2022
  • 1% payment adjustment April 1 – June 30, 2022
  • 2% payment adjustment beginning July 1, 2022 

The adjustment periods are dates of service and are identifiable on the Medicare remittance with Claim adjustment reason code (CARC) 253. The code will appear as a CO 253 RA "Sequestration – reduction in federal payment". Source

SNF Part A Coinsurance

The coinsurance rate has increased in 2022 from $185.50 per day to $194.50 per day. FCSO Notice

FISS DDE Annual Recertification – January 2022 Reinstatement

In response to the COVID-19 pandemic, Medicare Administrative Contractors (MACs) had suspended the annual recertification process for Medicare Part A providers who access the online claims processing system via Direct Data Entry (DDE). Beginning in January, First Coast Service Options (FCSO) and Novitas Solutions have begun mailing letters to Part A providers who have active DDE users.

The annual recertification letters will include a list of the users(s) associated with the Part A facility’s PTAN and instructions for completing the recertification. The authorized or delegated official listed on the provider’s CMS-855A enrollment must recertify each of the individual user(s) within 30 days of the date of the letter. Failure to recertify by the due date will result in the user(s) losing the DDE access to that facility’s PTAN. See the notice posted by Novitas Solutions

Part B Therapy Services Under CQ/CO Modifier 

Beginning 1/1/2022, occupational therapy and physical therapy services furnished by OTAs or PTAs that are billed under the CQ/CO assistant modifiers will receive a reduced payment at 85% of the otherwise applicable Part B payment. See the examples provided by CMS

If you have any questions about reimbursement or billing, please do not hesitate to reach out to a member of our Healthcare team!

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