CMS Requests Palmetto GBA Indefinitely Delay Its' Plans to Auto-Cancel Claims

Bill Finerfrock, Executive Director



The following message is posted on the Palmetto website.

Palmetto GBA and CMS have received a number of inquiries from providers and their representatives concerning provider appeal rights as well as information on how impacted providers may re-bill responsible MA plans. CMS is working to address these concerns and provide information to MA plans that will help them be better able to identify any rebilled claims from providers. So as to afford the agency with the time needed to develop complete guidance on these topics, CMS has requested that Palmetto GBA indefinitely delay its’ plans to auto-cancel claims for providers who have not submitted a valid exception request by August 17th. Additional information will be forthcoming in the next few weeks. Please review this information and share it with your staff.

NARHC has been working with CMS staff to resolve this mess in a way that will not be harmful to RHCs and their patients. Other groups, representing physicians, hospitals and others have joined us in this effort. We are pleased that CMS has decided to suspend recoupment indefinitely until we can put a process in place that resolves ALL of the issues – in particular the timely filing problems and resubmitting claims to MA plans.

While this announcement does not resolve the problem, it does provide much needed time to work out a permanent solution that does not harm RHCs or their patients.

We will continue to work with CMS and other stakeholder groups and their legal counsel until this matter is resolved.

Please do not hesitate to contact NARHC if you have any questions, 866-306-1961 x4.

Bill Finerfrock