CMS Instructs Medicare Contractors to Hold Claims through June 17

The AMA reports that the following message from CMS indicates that the Medicare contractors have been instructed to hold claims for services provided in June for an additional three business days.  This means that unless Congress sends legislation averting the cut to President Obama for signature within the next few days, carriers will begin processing claims with the 21% cut on Friday, June 18th.  CMS acknowledges in this message that the additional delay could pose cash flow problems for some physicians.

The choice between not getting paid from Medicare at all or getting paid 79% of current rates places physicians between a rock and a hard place with no good options.  If Congress fails to act before Friday, then carriers will start processing June claims at the reduced rates and, whenever Congress does act, these claims will need to be reprocessed and retroactively adjusted.  To avoid the hassle of reprocessing, practices that can afford it may wish to hold claims themselves until after the issue is resolved.

There is only one truly good option and that is for Congress to repeal the formula that produces these cuts.  Click here to contact your Representatives and Senators and ask them to act quickly to fix the SGR.

CMS Message to Physicians:The 2010 Medicare Physician Fee Schedule

The Continuing Extension Act of 2010, enacted on April 15, 2010, extended the zero percent (0%) update to the 2010 Medicare Physician Fee Schedule (MPFS) through May 31, 2010.  At this time, Congress is debating the elimination of the negative update that took effect June 1, 2010.  The Centers for Medicare & Medicaid Services (CMS) is hopeful that Congressional action will be taken within the next several days to avert the negative update.

To avoid disruption in the delivery of health care services to beneficiaries and payment of claims for physicians, non-physician practitioners, and other providers paid under the MPFS, CMS had instructed its contractors on May 27th to hold claims for services paid under the MPFS for the first 10 business days of June (i.e., through June 14, 2010).  This hold only affects MPFS claims with dates of service of June 1, 2010, and later.

Given the possibility of Congressional action in the very near future, CMS is now directing its contractors to continue holding June 1 and later claims through Thursday, June 17, lifting the hold on Friday, June 18. 

This action will facilitate accurate claims processing at the outset and minimize the need for claims reprocessing if Congressional action changes the negative update.  It also should minimize the provider and beneficiary burdens and costs associated with reprocessing claims.

We understand that the delayed processing of Medicare claims may present cash flow problems for some Medicare providers.  However, we expect that the delay, if any, beyond the normal processing period will be only a few days.  Be on the alert for more information regarding the 2010 Medicare Physician Fee Schedule Update.


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