06/18/2010

Update on Physician Medicare Payments

CMS to Process Payments at Reduced Rates

Update on Physician Medicare Payments 

As you know, CMS has been holding physician claims since June 1 in anticipation of congressional action to avert the scheduled 21.2 percent reduction in payment scheduled for the start of this month.  While the House recently acted to pass a 19-month extension, the Senate was unable to move the House version of the bill.  Today, the Senate approved a measure providing a 2.2 percent update to payments for six months (June thru November).  However, that measure still requires House approval before becoming law.  We expect that to happen early next week. 

In the absence of a change in the law, CMS announced today that they are lifting their hold on claims.  Today the agency instructed its contractors to begin paying claims based on the 21.2 percent reduction.  Below is a copy of the message from CMS.

The Continuing Extension Act of 2010, enacted on April 15, 2010, extended the zero percent update to the 2010 Medicare Physician Fee Schedule (MPFS) through May 31, 2010. On May 27, 2010, the Centers for Medicare & Medicaid Services (CMS) initially instructed contractors to hold claims for services paid under the MPFS for the first 10 business days of June. On June 14, CMS extended this hold for an additional three business days (i.e., through June 17, 2010). This hold only affected MPFS claims with dates of service of June 1, 2010 and later. The CMS today directed contractors to lift the hold and begin processing June 1 and later MPFS claims under the law's negative update requirement. Held claims will be released and processed on a flow basis, first-in/first-out.Congress continues to debate the elimination of the negative update that took effect June 1, 2010. The CMS is hopeful that Congressional action will be taken to avert the negative update. We continue to monitor Congressional actions, and if Congress changes the negative update that is currently in effect, we are prepared to act expeditiously to make the appropriate changes to Medicare claims processing systems.

We will continue to keep you apprised of changes that affect the rates paid for ASC services based on the Medicare physician fee schedule.