Tricare will make payment adjustments

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Friday, July 7, 2017

WASHINGTON – Tricare, the healthcare program for uniformed services members and their families, will also adjust payments from June through December 2016 per a provision in the 21st Century Cures Act, according to AAHomecare.

The provision in the Cures Act requires Medicare to retroactively delay a second round of reimbursement cuts in non-bid areas from July 1, 2016, to Jan. 1, 2017, allowing providers to recoup a portion of six months worth of payments.

In a letter responding to HME providers who inquired about whether Tricare, which bases its payments on Medicare’s payments, would also make adjustments, Tricare stated: “You are correct TRICARE uses Medicare’s DMEPOS fee schedule, Medicare reduced their rates in the second half of 2016, and a subsequent resolution (the 21st Century Cures Act) delayed that reduction, and retained the original, higher rates for claims with dates of service between July 1 and December 31, 2016.  TRICARE followed suit and we suggest you resubmit any claims adjudicated under the reduced rates to the Managed Care Support Contractor (MCSC) in your region for reprocessing.”

In response to the news, Laura Williard, vice president of payer relations for AAHomecare, advises providers to submit a small batch of claims to ensure they are processed correctly before submitting all claims.

Williard also advises providers who have not already done so to submit similar letters inquiring about the adjustments in case they are questioned by the contractors administering Tricare contracts.

The news culminates six months of work by Williard and AAHomecare on this issue. They reached out to Tricare and its contractors, marshaled providers to pressure the program, and even secured legal opinions confirming that Tricare was obligated to follow the Cures provision.