2023 Medicare Payment Reminders

The Centers for Medicare & Medicaid Services (CMS) provides guidance on payment ceilings, and states that all claims (including paid claims, partial and complete denials, no payment bills, PIPs [Periodic Interim Payments], and Electronic Media Claims [EMCs]) must be paid within 30 days or less from the date the completed claim is received. (IOM Publication 100-4, Chapter 1, Section 80.2.1.1, Medicare Claims Processing Manual [PDF]).

Providers are accustomed to receiving payment as early as the 14^th day after claim receipt. At the direction CMS, and with the application of annual fee schedules, it may appear as though payments are delayed. Additionally, provider payments in early 2023 may appear lower than usual because of the application of patients' 2023 deductibles. Other reasons for payment differences may be due to Quality Payment Program individual provider adjustments (negative, positive or neutral adjustments) for applicable providers, and required Medicare Fee For Service 2% Payment Adjustments, or sequestration. Each of these reductions are clearly noted on Medicare remittance advice with appropriate claim adjustment reason and/or remark codes.

Providers are encouraged to check the status of claims using the Palmetto GBA eServices portal and note the date of claim receipt to calculate the 30-day payment ceiling. Remittance advice may be viewed through the eService portal to understand other adjustments that may be applied to a claim. Looking solely at the dollar amount received from Medicare in January 2023 as compared to December 2022 is not a true picture of Medicare reimbursement when adjustments may have been applied.

Resources

• Palmetto GBA eServices Portal
• Jurisdiction J Part B — Fee Schedules
• Jurisdiction M Part B — Fee Schedules