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Breaking News: CMS Submits Change Request for Cures Act Adjustments

On Thursday morning, CMS submitted a change request, which provided instructions regarding the implementation of section 16007 of the Cures Act signed into law December 2016. The change request in its entirety may be viewed here.

This request outlined guidance to the DME MACs for the retroactive reimbursement for rural and non-bid providers for equipment and services furnished between July 1 and December 31, 2016.

This change request appears to be the initial steps for DME MACs to create a process to adjust claims to the new fee schedule and conduct a mass reprocessing of these claims. Simply put, this means that providers will not be required to resubmit any new claims within the July-December 2016 timeframe.

The request has an implementation date of July 3, 2017 but also notes that DME MACs can start reprocessing claims as soon as the revised fee schedules are loaded into their systems. The release also goes to state that MACs will be able to download the revised files “on or after May 1, 2017.”

Provider materials outlining these changes will soon be available on CMS’ website within the coming week.

This release is welcomed news as providers will not be expected to take on the administrative burden to resubmit thousands and thousands of claims. While this is a great win for providers, waiting until May 1st, is far too long to recoup those owed dollars. Providers are encourage to reach out to their members of Congress to ask for this revision date to be moved up. The fight still continues to make long-term reforms to the competitive bidding program to ensure patients maintain high access to quality care.

VGM will continue to publish any further information as it becomes available.