Some Medicare Claims Are Being Reprocessed Due to Federal Budget Bill Provisions

Claim_computer_keyboard-articleNew Medicare provisions in the Bipartisan Budget Act of 2018 require Medicare Administrative Contactors (MACs) to reprocess some types of claims. The Centers for Medicare and Medicaid Services (CMS) has instructed MACs to begin reprocessing those claims starting April 2, 2018.

Certain Pennsylvania physicians and practices will see increased reimbursement due to these reprocessed claims. Some of the affected claims include:

  • Claims which were affected by the Work Geographic Practice Cost Index (GPCI) fee increase for 2018—Some states and localities were affected by this increase, including the area CMS categorizes as “Rest of Pennsylvania” (this includes all of Pennsylvania, with the exception of the Metropolitan Philadelphia locality). The Work GPI for “Rest of Pennsylvania” was increased from 0.990 to 1.000.
  • Certain therapy claims with the KX modifier—The budget bill repealed the Medicare cap for outpatient therapy services for services on or after Jan. 1, 2018. This change impacts some claims using the KX modifier.

For complete details regarding the types of claims that will be reprocessed, check out CMS’s MLN Matters article here.

If you have questions on claims reprocessing, you can contact Novitas Solutions, Pennsylvania’s MAC, at 1-877-235-8073.

Pennsylvania Medical Society (PAMED) members can also contact our Knowledge Center at 855-PAMED4U (855-726-3348) or

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