Table of Contents
What is the 2% Medicare sequestration?
Under a BCA mandatory sequestration order, Medicare benefit payments and Medicare Integrity Program spending cannot be reduced by more than 2%. Under a Statutory PAYGO sequestration order, Medicare benefit payments and Medicare Program Integrity spending cannot be reduced by more than 4%.
What is a sequestration payment reduction?
Medicare claims with dates-of-service or dates-of-discharge on or after April 1, 2013, incur a 2% reduction in Medicare payment. These are known as Medicare Sequestration Payment Reductions.
Does sequestration apply to Medicare Advantage?
The payment reduction, referred to as sequestration, is applied to the Net Capitation Payment (NCP) made to the plans, including MAOs. Therefore, Medicare rates and fee schedules remain unaffected by sequestration.
Is sequestration based on date of service?
A: The sequestration order covers all payments for services with dates of service or dates of discharge (or a start date for rental equipment or multi-day supplies) on or after April 1, 2013.
What does sequestration reduction amount mean?
According to the Congressional Research Service, sequestration is a reduction in federal spending by a certain percentage. As this applies to Medicare, the reduction in federal spending means providers receive less payment for services, specifically by two percent.
How much is 2% of the sequestration amount?
However, due to the sequestration reduction, 2% of the $36.00 calculated payment amount is not paid to the beneficiary, resulting in a payment of $35.28 instead of $36.00 ($36.00 x 2% = $0.72).
How are sequestration payment adjustments applied to Medicare claims?
Answer: Payment adjustments required under sequestration are applied to all claims after determining the Medicare payment including application of the current fee schedule, coinsurance, any applicable deductible, and any applicable Medicare Secondary Payment adjustments.
How do I report sequestration reduction in Medicare fee-for-service?
Mandatory Payment Reductions in the Medicare Fee-for-Service Program. Claim adjustment reason code (CARC) 253 is used to report the sequestration reduction. The code will appear as a CO 253 on the RA “Sequestration – reduction in federal payment” as the reason.
How will sequestration affect my fee schedule?
All fee schedules, Pricers, etc., are unchanged by sequestration; it’s only the final payment amount that is reduced. Question: If a Durable Medical Equipment capped rental period started before April 1, 2013, are the rental payments for months after April 1, 2013, subject to the 2% reduction?