July System Updates Offer Reopening Opportunities for Quick Cash

Retro application of the KU modifier on complex rehab chair (K0848-K0864). The KU modifier is a pricing modifier (created in July but effective for DOS after January 1, 2016). KU should be added to wheelchair accessory HCPCS used with complex rehab bases (K0848-K0864). The KU secures a higher reimbursement rate guaranteed by PAMPA (passed into law on December 28, 2015 and provides an exemption from competitive bid rate decreases). Due to system limitations, the MACs could not properly pay these claims between January 1, 2016 and July 5, 2016. Affected claims need to be reprocessed to pay at the higher fee schedule. The MACs are instructing suppliers to request a reopening of these claims by sending in a spreadsheet of affected claims to the respective reopening department. We recommend querying your billing software for complex chair bases (K0848-K0864) delivered between January 1, 2016-July 5, 2016 to identify the affected population of underpaid accessories. 

The spreadsheets should include:

• The beneficiary's name
• The Medicare Health Insurance Claim Number (HICN) of the beneficiary
• The specific services(s) and/or item(s) for which the reopening is being requested and the specific date(s) of service,
• The wheelchair base with which the accessory is being used
• The supplier’s PTAN
• The printed name and signature of the person filing the request

Retro application of the correct allowable for HCPCS E1012. CMS erroneously reported the fee schedule allowable for the center mount power elevating leg rest HCPCS E1012. This is a capped rental accessory and in January 2016 the monthly allowable was posted as $94.99. However, the correct allowable should have been $102.90. The corrected allowables were not updated in the system until the July 5 release. However, if you billed E1012 with dates of service between January 1, 2016 to July 1, 2016, and these claims completed processing prior to the July 5 release, you will need to request a reopening to reprocess your claims and secure the extra $7.91 (KH/KI modifiers) or $5.94 (KJ modifier) in reimbursement for the monthly rental of this capped rental item.

Retro application of the correct allowables for A6450 and A6451. Two compression bandage codes have been assigned a specific fee schedule of $1.94/unit (A6450, A6451). Providers that billed these items prior to assignment of the fee schedule in July can have claims reprocessed back to service dates of January 1, 2016 and after.
 
If you provided any of these three services between January and July, utilize the reopening process to get these claims adjusted in a prompt fashion.  

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