Medicare claims to be adjusted due to Affordable Care Act and 2010 MPFS

11 February 2011

On March 23, 2010, Pres. Obama signed into law the Affordable Care Act and various provisions of the new law were effective April 1, 2010. Corrections to the 2010 Medicare Physician Fee Schedule (MPFS) were implemented at the same time as the Affordable Care Act revisions to the MPFS, with an effective date retroactive to Jan. 1, 2010. A large volume of Medicare fee-for-service claims will be reprocessed because of the retroactive effective dates of these provisions and the MPFS corrections.

The Centers for Medicare and Medicaid Services (CMS) is working to begin processing the adjustments to claims affected by the post-effective date implementation of select provisions of the Affordable Care Act and the 2010 MPFS. Most of the adjustments will be made automatically.

Please note that any claim that contains services with submitted charges lower than the revised 2010 fee schedule amount (MPFS and ambulance fee schedule) cannot be automatically reprocessed at the higher rates. In these cases, physicians must request a manual reopening/adjustment from their Medicare contractor. Medicare claims administration contactors will follow the normal process for handling any applicable underpayments or overpayments that occur while reprocessing claims.