By November 1, 2021, the U.S. Centers for Medicare & Medicaid Services (CMS) will begin reprocessing claims for outpatient clinic visit services provided at excepted off-campus Provider-Based Departments (PBDs) so they’re paid at the same rate as non-excepted off-campus PBDs for those services under the Medicare Physician Fee Schedule (PFS).
This affects certain claims with dates of service between January 1 and December 31, 2019. CMS will reprocess all affected claims. Providers will need to refund the coinsurance difference to patients (or payers) who paid the higher coinsurance rates based on new remittance advice information.
Source: U.S. Centers for Medicare & Medicaid Services (CMS)
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