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CMS Releases Guidance to DME MACs on CURES-Mandated Reimbursement Adjustments for Rural/Non-bid Providers

CMS today released guidance to the DME MACs for retroactive reimbursement adjustments for rural/non-bid area providers for equipment & services furnished between July 1-Dec. 31, 2016. These adjustments follow provisions in last year’s CURES legislation providing a measure of relief for rural/non-bid area providers.

From our initial reading of the guidance, it appears that CMS will recalculate the fee schedule to extend the 50/50 blended fee schedule in effect from Jan. 1-June 1, 2016 to the July 1-Dec. 31, period, and have added the KE modifier back to the fee schedule file. The revised file will be available to the DME MACs for download on or after May 1, 2017.

Although the implementation date on CMS’ guidance is set for July 3, 2017, it is noted that DME MACs can start reprocessing the affected claims as soon as the revised fee schedule files are loaded into their systems.

Suppliers will not need to submit any new claims or other materials.  The DME MACs will create a one-time process to validate and adjust claims using the new fee schedule, and will automatically perform a mass reprocessing of the claims.  If a supplier subsequently believes the DME MACs missed reprocessing their claims, the supplier will then need to submit a request.

The guidance also notes that a provider education article related to this issue will be available at the MLN Matters section on the CMS website shortly.  We will provide additional perspective on the guidance as it becomes available.
While this interim relief is welcome news for rural and non-bid area providers, AAHomecare remains committed to advocating for a longer-term solution to deliver sustainable reimbursement rates for rural and non-bid area providers.

CMS’ full guidance can be found here.

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