New Update: Reinstating Medicare 2 Percent Payment Reduction

Please see the December 2021 update below regarding the sequestration moratorium.

Dec. 20, 2021 Update: Congressional leaders announced agreement on a bipartisan deal to provide full relief from the 2% Medicare sequester cut for both participating providers and non-participating provider from January 1, 2022, through the end of March 2022. From April 2022 through June 2022 a 1% sequester cut will be in effect, with the full 2% cut resuming thereafter.

Jun. 3, 2021 Update: Congress has passed legislation that continued the moratorium on sequestration. As a result, CMS has extended the moratorium on sequestration until December 31, 2021. To align with CMS, Blue Cross NC has followed suit and left sequestration suspended for both participating providers and non-participating providers.

Feb. 23, 2021, Update: Based on questions we've been receiving, we have updated the article below with the "Background/Additional Information" section.

Feb. 11, 2021, Update: Due to the recent federal legislation changes, we have updated the following article, which was originally published on Oct. 20, 2020.

The Centers for Medicare and Medicaid Services (CMS) will be reinstating the Medicare 2 percent sequestration payment reduction on April 1, 2021.

As previously communicated, CMS temporarily suspended the Medicare Sequestration Alignment policy (PDF), and Blue Cross and Blue Shield of North Carolina (Blue Cross NC) adjusted its processes to align with that decision. With the reinstatement by CMS, the following applies to members on Medicare Advantage plans offered and administered by Blue Cross NC, including Experience Health.

• Participating providers: For dates of service from May 1, 2020, through December 31, 2020, and from February 15, 2021, through March 31, 2021, Blue Cross NC will not apply the Medicare 2 percent sequestration reduction in payments being made to participating providers.
  
• Non-participating providers: For dates of service from May 1, 2020, through March 31, 2021, Blue Cross NC will not apply the Medicare 2 percent sequestration reduction in payments being made to non-participating providers.
• For dates of service on or after April 1, 2021, the Medicare 2 percent sequestration reduction will be applied and the Blue Cross NC policy will resume.

Background/Additional Information

When CMS first suspended sequestration payment reductions in 2020, Blue Cross NC announced that it would align with CMS and suspend application of our sequestration reimbursement policy through December 31, 2020. When Congress passed the Consolidated Appropriations Act at the end of December, Blue Cross NC decided, again, to align with CMS and continue the suspension of our reimbursement policy. However, the law was passed so late in the year that we had already passed the point where we could continue the suspension without interruption due to additional system configuration that was required. Therefore, we decided to reinstate the suspension beginning on February 15, 2021, and running through March 31, 2021. We will not be adjusting claims for the interim period between January 1, 2021, and February 14, 2021.

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