CMS Offers Claim Processing Guidance to Split Outpatient Claims
Recently, HCAM’s national affiliate —the American Health Care Association (AHCA) — reached out to the Centers for Medicare and Medicaid Services (CMS) because some providers received incorrect payments for March 2024 Medicare Part B services, including physical and occupational therapy and speech-language pathology services furnished March 9 through March 31, 2024. As a result, CMS posted guidance for providers impacted by this or similar issues in the MLN Matters weekly update.
CMS Guidance: If you submit outpatient claims (or inpatient ancillary claims reimbursed under Part B) that include Physician Fee Schedule pricing, you may want to split a single claim into two claims to get updated rates in certain situations. Examples of these situations include when CMS applies the CY deductible or implements an off-cycle Physician Fee Schedule quarterly release.
The types of bills impacted include the following:
- Hospital: 12X and 13X
- Skilled nursing facility: 22X and 23X
- Home health agency: 34X
- Outpatient rehabilitation facility: 74X
- Comprehensive outpatient rehabilitation facility: 75X