It’s like the more money we come across,
The more problems we see.”
- The Notorius B.I.G.
I love HGTV. It amazes me every time they transform a ratty kitchen or bathroom into something straight from the pages of a magazine. It inspires me. The problem is that it also convinces me I can renovate my entire house in 30 minutes (excluding commercials, of course).
I worry the retroactive delay to fee schedule cuts in the 21st Century Cures Act may be a bit of the same. There is little doubt that reprocessing six months of affected Medicare claims will generate significant amounts of cash for many providers. The mere reprocessing of claims, however, no more reflects the complete responsibility for the provider than the delivery of cabinetry results in a completely remodeled kitchen.
Tennessee suppliers went through something like this last year when BCBS of TN and the TN Medicaid program reprocessed a boat load of claims to pay providers additional amounts that they were due. It was kind of a nightmare. See, remittances from those payers normally post automatically to the billing system...just as the original Medicare payments did between July 1 and December 31, 2016. Unfortunately, most systems cannot automatically post a payment to a claim line with a zero balance...which all of the affected claims currently have after properly posting the original EOB. So those giant Medicare remittances that usually take less than an hour to post...yeah, they all have to be manually posted now.
But wait, there's more...
It is not as simple as posting the amount on the EOB. Whip out those calculators because, as we say in South Carolina, we have some figurin' to do. For each affected claim line, payment posters must manually calculate and post the difference between the original payment and the reprocessed claim amount. We cannot know for sure without definitive plans from the MACs, but I suspect the staff time and effort to properly post these claims could be 10 to 20 times that of regular posting activity.
Moreover, providers may not be able to set these reprocessed claim remittances aside and post them later. If this is anything like the great Tennessee Charlie Foxtrot of 2016, the reprocessed claims will be intermingled with the current payment and denial activity. Wholly ignoring remittances with the reprocessed claims can really derail your current billing operations.
MiraVista is developing processes to manage the retroactive delay as efficiently as possible. If you want to know more about the benefits and requirements of the 21st Century Cures Act, please join us at 2 PM EST on February 16, 2017, for Give it to me straight, Doc: What Suppliers Need to Know About the Cures Act.