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Outpatient Institutional Providers Reimbursed Under MPFS: When to Split Claims for Updated Rates
If you have monthly outpatient and/or inpatient ancillary claims with DOS 3/1/2024 – 3/31/2024, you may take the following steps to ensure correct payment. Splitting the March 2024 monthly claim allows application of the most current MPFS rates applicable per DOS.
- For processed claims in PB9997 with DOS 3/1/2024 – 3/31/2024 you can submit an adjustment (XX7 type of bill) to the paid claim to change the claim’s FROM date to 3/8/24 or earlier (as applicable) and update the charges accordingly.
- Once the adjustment processes and finalizes (PB9997), a claim for DOS 3/9/2024 – 3/31/2024 (or as applicable) with the appropriate charges can be submitted.
- For claims not yet submitted, you should submit one claim for DOS 3/1/2024 (or as applicable) - 3/8/2024 and a second claim for DOS 3/9/2024 - 3/31/2024 (or other dates in March as applicable).
It is important to note that you should not appeal these claims, as the Appeals department cannot change the MPFS rate on the processed claim. The claim must be split as outlined above if you wish to receive the MPFS rate that became effective on 3/9/2024. In addition, National Government Services will not be initiating mass adjustments to correct these claims, therefore you should review your March 2024 claims that may be impacted by the MPFS rate change and take the appropriate action(s) as listed above.
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Posted 7/1/2024