• News New Blog Banner

  • CMS Begins Reprocessing Therapy Claims Subject to 2010 Medicare Fee Schedule Changes

    The Centers for Medicare and Medicaid Services (CMS) has begun to automatically reprocess a large volume of claims paid to physical therapists and other providers under the 2010 physician fee schedule because the fees were affected by some provisions with retroactive dates that were included in the Affordable Care Act passed last year. For therapy services, most of the claims have resulted in increases in payment of about 50 cents.

    Recently, CMS sent a notice informing providers that the agency has had difficulties when reprocessing claims involving therapy services. The challenge occurs when the KX modifier was not used because the patient had not reached the therapy cap, but subsequently the patient received therapy services beyond the cap. In these instances, the claims adjustments were rejected and CMS was seeking recoupment from the providers for the original claims. To prevent this from occurring, CMS announced it will no longer automatically reprocess claims involving services subject to the cap. However, providers may request contractors to reprocess these therapy claims.


    • CMS has been doing this for at least 6 weeks. We have already been asked to return $18.63 (for services provided to 84 patients. This refund of on average 20 cents per encounter is costing everyone hundreds of dollars. What a waste!!!!

      Posted by Charles Kibbey on 7/2/2011 9:16 AM

    • In addition, it affects the seconary payors and can result in reprocessing (or UN-processing) of THOSE claims... which further increases the administrative burden and cost for the providers.

      Posted by Sarah Dyer on 7/5/2011 10:55 AM

    • I completely agree with Charles. I cannot believe all the extra work this has caused and for pennies.

      Posted by Carol Barker on 7/6/2011 6:45 PM

    Leave a comment
    Name *
    Email *