CMS Cancels Mass Claims Adjustment
July 11, 2003 - The Centers for Medicare and Medicaid
Services (CMS) June 26 announced that it would cancel the
mass claims adjustment scheduled to begin on July 1. The automatic
adjustment of claims was planned to correct overpayments and
under payments that occurred due to the delay in implementing
the 2003 Physician Fee Schedule.
Under the original plan, CMS intended to direct carriers
to automatically adjust claims that were processed under the
2003 Physician Fee Schedule for services that were performed
between January 1, 2003, and February 28, 2003, while the
2002 Physician Fee Schedule was still in effect. CMS planned
to have beneficiaries notified when the processing caused
their co-pays to change as well. However, after reviewing
data from one multi-state carrier that indicated approximately
250,000 claims and 100,000 beneficiaries per state would be
affected, CMS reconsidered the plan. Based on this data, CMS
estimated that the adjustments would take more than a year
to complete and would severely tax the carriers' computer
systems. CMS has decided instead to direct carriers to adjust
claims only when the physician brings the claim to the carrier's
attention.
Various news sources have reported that the decision to waive
the automatic claims adjustment is estimated to result in
an increase in Medicare spending of approximately $50 million
in 2003. According to these sources, CMS is planning an offsetting
adjustment to the Sustainable Growth Rate allowance to compensate
for the increased expenditures.
Information:
Denise Dodero, Associate Vice President
AAMC Health Care Affairs
ddodero@aamc.org
(202) 828-0493
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