Sequestration, a common hurdle for any healthcare payer under Medicare’s Fee-for-Service (FFS) program, often involves tedious manual processes. Let’s delve into this challenge and discover how SymKey frees you from this time-consuming burden.
What is Sequestration? Simply put, it’s a federal budget control measure that reduces the amount Medicare pays to providers through mandatory reductions to provider payments for Medicare FFS claims.
An enforcement mechanism for three budget enforcement rules created by the Statutory Pay-As-You-Go Act of 2010 (Statutory PAYGO; P.L. 111-139), the Budget Control Act of 2011 (BCA; P.L. 112-25), and the Fiscal Responsibility Act of 2023 (FRA; P.L. 118-5). Subsequent legislation extended sequestration for mandatory spending through FY2031 and the sequestration of only Medicare benefit payments spending through FY2032. CMS does not dictate payment arrangements between Medicare Advantage Organizations (MAOs) and providers; these are based on the terms of their contracts.
Sequestration processes often require significant time and manual effort requiring staff to re-enter a claim and/or adjust it after it has been paid. Given timely compliance regulations, it is not feasible to hold payment of a claim while waiting for CMS updates to the correct sequestration. This means that all too often, payers must pay claims they know will eventually need to be reprocessed, in some cases manually.
HCIM's Role in Simplifying This Complexity:
HCIM is here to help you navigate the intricate landscape of Medicare sequestration.
SymKey's Automated Solution:
- Accurate Calculation: If sequestration is not applied automatically to unpaid claims, SymKey can calculate the correct amount and apply it along with required adjustment codes.
- Automated Workflow: If sequestration was not applied to claims that have already been paid, SymKey can reprocess the paid claim to apply the sequestration amount, the adjustment code for the sequestration, and applicable notes to the claim.
- Correct Sequence: SymKey queries are written and executed, and if there are more than one, they will run in specific order.
By harnessing the power of IntelliRPA® automation, SymKey users can effectively manage the complexities of Medicare sequestration, turning potential manual headaches into a smooth process.
Ready to simplify sequestration and enhance your operational efficiency? Discover how HCIM can transform your claims processing. Contact us today to learn more and get started!