CMS Instructs DME MACs on CURES Reimbursement

CMS outlines how DME MAC contractors are to begin implementing retroactive reimbursement per the law.

• By David Kopf
• Feb 09, 2017

CMS has released guidance instructing the DME MACs on how they should process the retroactive reimbursement for claims impacted by bid expansion, as mandated by the 2016 CURES Act. However, providers might want to be patient as reimbursement is not expected until at least May.

The Act, which became law last December, includes provisions that required CMS to provide retroactive relief to non-bid providers impacted by the 2016 national expansion of competitive bidding. The Act required CMS to extend the initial phase of partial reimbursement cuts to impacted items from ending on June 30, 2016 to ending on Dec. 31, 2016. The full cuts, which had started on July 1, 2016, were then pushed to Jan. 1, 2017. CMS was instructed to retroactively reimburse claims filed between July 1, 2016 and Dec. 31, 2016 for the difference between the partial reimbursement cut and the full reimbursement cut.

Under CMS's guidance, which the agency released at http://bit.ly/2loPPZ8, CMS says it will provide a revised fee schedule to the DME MACs on or after May 1, 2017. The DME MAC contractors must then reprocess the affected claims and to begin a “one time claims adjustment process” to reimburse the claims. CMS officially set the implementation date for the guidance at July 3, but instructed the DME MAC contractors to reprocess claims as soon as they had the revised fee schedule.

The guidance noted that CMS will provide an in-depth “provider education article” at the MLN Matters Articles site that DME MACs will then need to repost in order to educate providers.

“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,” the American Association for Homecare noted in a statement released after CMS distributed the guidance.