June 2010 Update - See Medicare Saga Continues...

April 16, 2010

Medicare Fee Cut Temporarily Averted - Again...

The 21% Medicare fee cut has been temporarily averted yet once again. The Medicare claim hold expired on April 14, 2010 and Thursday afternoon they announced that claims would be paid at the reduced rate. In typical last minute action, both houses reach a consensus for yet another termporary freeze. Thursday night, President Obama signed the law into effect and asked Congress to extend this bill for the remainder of 2010. Republicans are wary of the costs involved in further extensions since this bill is also tied to unemployment benefits. "It increases the deficit by $18 billion, a cost to be paid for by future generations," said Rep. Jerry Moran, R-Kan. "This legislation is yet another unfortunate example of business as usual in our nation's capital."

At least for now the freeze continues through May 2010.  We agree with Representative Moran's assessment that any further attempts to fix the Medicare payment system should be addressed through an entirely separate bill.

March 29, 2010

Medicare Suspends Claims Processing - Again...

Once again, Medicare claims will not be processed the first 10 business days of April 2010 while yet another piece of legislation tries to "fix" the problem.  A Bill extending the freeze until October has passed both the House and the Senate, but has not been signed by President Obama.  See March 1, 2010 update below for previous information about claims not being processed.

"On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA).  The Centers for Medicare & Medicaid Services (CMS) is working hard to expeditiously implement the new law.  The law's Medicare fee-for-service provisions have varying effective dates and our first priority is to address provisions with the earliest effective dates.  CMS is committed to assuring Medicare providers are well informed as early as possible.  For that reason, CMS is urging you to be on the alert for notices and instructions from CMS and from your Medicare fiscal intermediary, carrier, or Medicare Administrative Contractor, on forthcoming policy and operational changes as we implement the PPACA." - Centers For Medicare and Medicaid Services.

March 3, 2010

"On March 2, 2010, President Obama signed into law the “Temporary Extension Act of 2010.”  Among other things, this law extends through March 31, 2010, the zero percent update to the Medicare Physician Fee Schedule that was in effect for claims with dates of service January 1, 2010, through February 28, 2010.  Consequently, effective immediately, claims with dates of service March 1 and later which were being held by Medicare contractors will be released for processing and payment.  Please keep in mind that the statutory payment floors still apply and, therefore, clean electronic claims cannot be paid before 14 calendar days after the date they are received by Medicare contractors (29 calendar days for clean paper claims).

In addition, the new law extends through March 31, 2010, the exception process for therapy claims reaching the annual cap, retroactive to January 1, 2010.  Affected providers may submit claims for exceptions to the annual therapy caps, with dates of service January 1 through March 31, 2010, using the KX modifier, following the pre-January 1, 2010, requirements for therapy cap exceptions."
 

Claims are being processed, but the war isn't over. The battle will continue for at least another month.

**Editors Note:  Recent legislation to extend this freeze until October has passed both the House and the Senate.  This page will be revised as soon as any further updates are made available.

March 1, 2010

Medicare claims will not be processed the first 10 business days of March 2010 while Congress works on a fix for the dreaded 21% pay cut which officially takes place today. See www.instacode.com/medicare-2010-fee-cut for details on the pay cut.

A temporary measure to extend the January 1-February 28 freeze for another month passed the house, but was killed in a Senate filibuster. The Senate had issues with the bill that passed the House of Representatives late last week. The House bill included an extension of unemployment benefits among other things. Beginning Monday March 1, this issue is again on the table (official Congressional docket).  However, with a Circut Court Judge nomination pending, it is unlikely that much will happen until later in the week.

On Friday, February 26, 2010, the Centers for Medicare and Medicaid Services issued the following statement:

"The Centers for Medicare & Medicaid Services (CMS) is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other providers of services paid under the Medicare physician fee schedule (MPFS).  The Department of Defense Appropriations Act of 2010 provided a zero percent (0%) update to the 2010 MPFS effective for dates of service January 1, 2010, through February 28, 2010.  

We believe Congress is working to avoid the negative update that will take effect March 1, 2010.  Consequently, CMS has instructed its contractors to hold claims containing services paid under the MPFS for the first 10 business days of March. The holding of MPFS claims will only affect claims with dates of service March 1, 2010, and forward.  This hold should have a minimum impact on provider cash flow because, under current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt."

As of today, let's hope for a happy resolution and plan for a fee freeze. In the meantime, you may wish to NOT submit claims to Medicare for a few days. If you do submit a claim, it will not be processed until the fee problem has been resolved.

We will keep our website updated. If any changes are made to the payment system, InstaCode Institute will update our products with these changes as they become available.