Thresholds will not be applied to the November estimated payment. However, as the volumes of transactions are processed, threshold running totals will be altered beginning with the November 2000 Remittance Advice. If you are a physician who is reaching threshold during the period of November to January, then threshold reductions will be applied beginning the month you reach threshold. Thresholds will apply to the reconciliation payment, as appropriate.
The retroactive payment does not apply to the following fees that are excluded from the fee increase:
3. After Hours Hospital Services Exempt from Threshold Calculations
Effective April 1, 2000, after-hour, non-elective, hospital services provided during evenings, nights, weekends and holidays, as defined in the General Preamble B.11, are exempted from threshold calculations. If applicable, exempted services provided on or after April 1, 2000 will be removed from the physician's running threshold total. Further information regarding this process will be communicated at a later date.
Reminder: To enable processing of your claims, physicians are required to submit, all in-hospital after-hour non-elective services and associated services that are rendered to the same patient on the same claim record. No other services should be included on this claim record. Enter the hospital number on the claim. Claims that are submitted without a valid hospital number will not be exempted from the physician's threshold income.
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