CGS Administrators, LLC

September 1, 2017

Cures Act Adjustments - KE Modifier Reminder and Updates for the Supplier Community

Great news this week!  CGS has adjusted the vast majority of the Cures Act claims and some are still processing through the system.  Check those Remittance Advice Statements over the next few weeks for payment!

Since we are nearing the conclusion of the initial Cures Act adjustment phase, CGS wants to remind suppliers about the KE Modifier document we published last week.  The article outlines the requirements and process for having CGS Written Reopenings append the KE modifier for you.  Go to Adding the KE Modifier: Instructions for Reopening a Claim Adjusted Under the Cures Act to view the entire article and links to form templates.

We also want to take this opportunity to inform our suppliers of a few Cures Act claim processing issues that have been found.

Temporary Replacement of Beneficiary Owned Equipment (K0462) – CGS will review claims for this HCPCS code and assure that accurate payment has been made.  If not, CGS will adjust the claim during the individual review. There will be no action required on the part of the supplier.

Portable Oxygen Contents (E0443, for example) – An issue with payments was noted a few weeks ago and CGS conducted data analysis and then adjusted all of the claims.  There was no action required on the part of the supplier.  We will continue to monitor payment to verify accuracy.

Oxygen Concentrators (E1390) – The Cures Act adjustments were causing a payment in certain situations and, in some cases, allowing only 35 total rental payments.  CGS is aware of this system issue and has taken steps to monitor the adjustments and payments.    There will be no action required on the part of the supplier.

Heated Humidifier (E0562) – An issue was noticed when this inexpensive and routinely purchased category (IRP) item was billed as a rental and adjustments did not process appropriately.  Recall that any IRP item billed as a rental will pay up to the fee schedule allowance.  If the rental began prior to July 1, 2016, no additional payments will be made on claims for July 1, 2016, through December 31, 2016 dates of service because the fee schedule amount was already in effect, if you will.  CGS is aware of this issue and is currently reviewing data to verify accurate payments.  If claims need to be adjusted again, CGS staff will handle the adjustments.  There will be no action required on the part of the supplier.

We realize the Cures Act adjustment process is lengthy and somewhat cumbersome for you; CGS’ goal is to process all of these problematic claims on your behalf so you can spend time in other areas of your business. 

One final reminder – Watch for N869 remark code on all Cures Act adjustments.

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