Medicaid programs issue payment when the Medicare payment for a specific item does not exceed its established Medicaid fee schedule. When Medicare rates plunged last July, most Medicaid programs maintained their existing fee schedules without modification. As a result, Medicaid may have paid amounts that would not have been due immediately before the July Medicare reductions.
The Cures Act reprocessing initiative retroactively increases the Medicare payment rate for applicable dates of service. These additional Medicare payments create a variance between what Medicaid originally paid and the revised amount due. If the original Medicare payment was less than the Medicaid fee schedule and the Cures adjusted Medicare payment exceeds the Medicaid fee schedule, then the retroactive adjustment will result in a lower Medicaid payment than originally distributed. Medicaid may seek recoupment from the provider for the excess payment. Conversely, when the Cures Act adjusted Medicare payment remains below the Medicaid fee schedule, Medicaid should make additional payments.
Either way, posting reprocessed Medicare and Medicaid claims imposes a significant workload burden on your already busy billing department. If you are struggling with the cost benefit of posting reprocessed claims and want more guidance on how to prepare for the Cures claim adjustments, join us on June 1, 2017 at 2:00 pm EDT for our educational webinar The Prize has a Price: Endure Workload Increases from Cures Act Adjustments.