Medicare Outpatient change of rate

[Guest guest]

Don,

Yes, we received the same letter towards the end of January (we're a rehab

agency, too). Here is a portion of the letter from Mutual (we have until

April 1st according to the letter we received):

" The Medicare payment methodology for outpatient physical, occupational and

speech therapy, for services provided after December 31, 1998, was changed

from a cost based to a prospective payment system....

The claims processing system we utilize will not be modified to calculate

payment utilizing the revised methodology, i.e., prospective payment, until

approximately April 1, 1999. In order to prevent cash flow problems for

providers, we have been instructed by the Health Care Financing Administration

to continue to pay your claims utilizing the current cost based methodology

until the system is modified. Once the modification is made, we will

reprocess these claims utilizing the prospective payment methodology.

The temporary payment under the cost reimbursement methodology will likely

result in overpayments of your claims. When we reprocess the claims

correctly, we will process debit and credit replacement claims, which will

result in either recovery of payments made in error or issuance of additional

payments.

In addition, most coinsurance amounts we calculate during this interim period

will be invalid. Therefore, you should not bill Medicare beneficiaries any

coinsurance charges for outpatient physical, speech and occupational therapy

servies until after you have received your Remittance Advice for the

reprocessed claims paid utilizing the prospective payment methodology. In the

event you do collect an incorrect coinsurance amount, you will be reuqired to

refund any excess amounts, once we advise you of the correct coinsurance

amount. "

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[Guest guest]

A very strange letter arrived today in the mail from the Medicare

Provider Reimbursement & Audit Dept. in Dallas. It was a notice of a

change in our interim rate to take place on 03/01/99. I think we all

are under the impression that interim rates are not applicable after

12/31/98 for outpatient rehab agencies. Has anyone out there had a

similar letter?

Don Zylks, Ph.D., Administrator/Owner

South Texas Sports Medicine

Corpus Christi, TX

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