January 13, 2020
Area(s) of Interest: Advocacy Public Payors
In the proposed 2020 Medicare Physician Payment Rule, California Medical Association (CMA) physician analysts Edward Bentley, M.D., and Larry DeGhetaldi, M.D., found numerous errors in the California geographic payments. After CMA notified the Centers for Medicare and Medicaid Services (CMS), those errors were corrected in the final rule. However, Drs. Bentley and DeGhetaldi found that CMS made additional mistakes with the California geographic payments in the final rule. Once again, CMA notified CMS and they have acknowledged the errors. CMA is working with CMS to make the changes to ensure accurate Medicare payments are made to California physicians in 2020 and 2021 and to avoid recoupments in future years.
According to CMS, Noridian—the California Medicare contractor—is holding affected claims while they test and implement the corrected files. Noridian will begin reprocessing affected claims in late January.
CMA is pleased that CMS agreed to hold the claims until the payments are corrected in their payment systems. We believe it is the least disruptive way to handle the impacted claims. The corrections are expected to occur within the 14-day payment floor, thus we do not expect any payment delays as a result of this hold. The corrections will impact all California physicians except those practicing in Alameda, Contra Costa, Los Angeles, Orange, San Francisco, Santa Clara and Ventura Counties.
Once Noridian has corrected the payment amounts in its system, it will begin to process and adjust any affected claims. Physicians do not need to take any action. CMA is working with Noridian on the details and will provide additional information as it becomes available.
Physicians with questions can call (855) 609-9960 or visit the Noridian website for more information. To view the CMA letter to CMS regarding the payment error click here.