CMS by Nov. 1 will begin reprocessing certain claims for outpatient clinic visit services

The Centers for Medicare & Medicaid Services by Nov. 1 will begin reprocessing claims for outpatient clinic visit services provided at excepted off-campus provider-based departments so they are paid at the same rate as non-excepted off-campus PBDs for those services under the Medicare physician fee schedule, the agency announced today. This affects certain claims with dates of service between Jan. 1-Dec. 31, 2019. CMS said providers do not need to do anything and the agency will reprocess all affected claims. Providers will need to refund the coinsurance difference to patients (or payers) who paid the higher coinsurance rates based on new remittance advice information, according to CMS.