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Retroactive Medicare Fee Updates for Patient Protection & Affordable Care Act


CMS Provider Resources emailed the following notice regarding Medicare Retroactive Payment Corrections:


Important Message Regarding Medicare’s Implementation of the Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act of 2010


On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act.  One week later, on March 30, the President also signed into law the Health Care and Education Reconciliation Act of 2010.  These two new laws have a significant impact on the Medicare program and many of the provisions have effective dates prior to this point in time.  Over the past several weeks, the Centers for Medicare & Medicaid Services (CMS) has begun implementing various provisions of the new laws, including those with past effective dates.  In addition to implementing these legislative changes, the Medicare Physician Fee Schedule is being updated to include certain corrections, retroactive to January 1, 2010, as prescribed in recently published notices in the Federal Register.

Once Medicare contractors have the new payment files in place, per the above, all claims going forward will be processed at the revised rates.  However, we continue to work on the best way to address the many claims that are paid at the rates that were in place before the current corrections and updates are made.   Please be on the alert for further information about how CMS will address past claims.  Until then, providers should NOT resubmit previously-processed claims affected by the payment changes, as it is likely that these resubmissions may be denied as duplicate claims.

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