Make sure you plan for the Medicare fee-for-service pay reduction of 2 percent for claims with dates of service or discharge on or after April 1. The cut will affect both Medicare Part A and Part B, as well as contractual payments to Medicare Advantage Plans.
This change, part of mandatory across-the-board reductions in federal spending known as sequestration, is required by the Budget Control Act of 2011. The American Taxpayer Relief Act of 2012 postponed sequestration for two months.
In general, claims for durable medical equipment (DME) – prosthetics, orthotics and supplies, including claims under the DME Competitive Bidding Program – also will be reduced by 2 percent, based upon whether the date of service or the start date for rental equipment or multi-day supplies is on or after April 1.
Please note that claims payment adjustments should be applied to all claims after determining co-insurance, any applicable deductible and any applicable Medicare secondary payment adjustments.
While we all hope Congress will act to eliminate the mandatory payment reductions, at presstime for this issue, no action or delay had been announced. The Centers for Medicare & Medicaid Services encourages you to discuss the impact of sequestration with patients.
Direct your questions to Indiana’s Medicare administrative contractor, WPS, at the wps website or call Customer Service at (866) 234-7331.