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Corrections to 2016 Fee Schedule

Several Medicare Administrative Contractors (MACs) have indicated that they will hold claims from January 1 through January 14 in anticipation of corrections to the 2016 Medicare Physicians Fee Schedule.  National Government Services, NGS, states:

Holding of 2016 Date-of-Service Claims for Services Paid Under the 2016 Medicare Physician Fee Schedule

On October 30, 2015, the CY 2016 Medicare Physician Fee Schedule (MPFS) final rule was published in the Federal Register. In order to implement corrections to technical errors discovered after publication of the MPFS rule and process claims correctly, Medicare Administrative Contractors will hold claims containing 2016 services paid under the MPFS for up to 14 calendar days, (i.e., Friday, January 1, 2016 through Thursday, January 14, 2016). The hold should have minimal impact on provider cash flow as, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt.

MPFS claims for services rendered on or before Thursday, December 31, 2015 are unaffected by the 2016 claims hold and will be processed and paid under normal procedures and time frames.

If additional changes occur, we will post an updated news item to keep you informed.

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