1. Medicare Mass Adj 2017 | HDMS

2. Here’s what we know about the Mass Adjustment Repayment from Medicare…
Agenda
Here’s what we know about the Mass Adjustment Repayment from Medicare…

3. Medicare is giving you a little more money on some old claims.
What’s going on?
Medicare is giving you a little more money on some old claims.
Rural CBA and
Non-Bid Area claims based on patient’s zip code
Dates of Service
July 1st - Dec 31st 2016

4. News from CMS & MACs
CMS instructed the MACs to identify claims and pay Providers.
New fees have been published for these old claims.
MACs indicate millions of claims are involved, so payment will be spread out over many weeks.
January
May
May

5. Remittance Info
MACs have indicated that claims will be processed over a period up to 24 weeks.
MACs have indicated that there will be no unique identifier, so call centers will have no status.
MACs have indicated that these mystery payments will be mixed in with your regular payment files.

6. Batten down the hatches.
Revenue Question: Do you have unconfirmed orders from 2016?
If YES: if you update the CBA files before confirmation, the claims will have the NEW fees when revenue is created
Action Required:
Update your existing
CBA & Allowable rates with the new files available on the USS Support Site to establish the new repayment rates.

7. What to expect in HDMS
Claims receiving additional payment will most likely already be paid and/or moved to secondary payers.
Repayment claim will pop out on Autoposting Exceptions as “Balance ≥ $0” =

8. Taking Action in HDMS
Access Medicare claim via Claim Maintenance Change Allowed amount to reflect new rate, post changes Access same claim in Cash Posting, post payment
BEFORE
AFTER

9. What if claims are unpaid?
What to expect in HDMS
What if claims are unpaid?
If they were created prior to this project, they will be sitting at the old allowed rate =

10. Taking Action in HDMS
Access Medicare claim via Claim Maintenance Change Allowed amount to reflect new rate, post changes Claim will show positive MAC W/O
BEFORE
AFTER
*Note: rebilling claims to system determined payer does not bounce them against the CBA table, please adjust manually.

11. How will I know how much “Mass Adjustment Payment” to expect?
What to expect in HDMS
How will I know how much “Mass Adjustment Payment” to expect?
Query claims based on DOS and Zip codes then apply the difference in fee schedules =

12. Taking Action in HDMS
We are working on a report that will identify eligible claims and provide repayment amounts expected by Provider and Payer.
Can be used before, during, or after mass adjustment to determine scope and outcome of project.
Cloud Clients: we will need to hear from you about whether or not to update your CBA Files.

13. Questions? Lisa Anderson Education & Outreach lisaa@universalss.com
x 334
USS Customer Support
x 1