President Signs Bill Extending Medicare Physician Payment Freeze Through May 31

The Centers for Medicare & Medicaid Services (CMS) released the following statement this morning:

 On April 15, 2010, President Obama signed into law the “Continuing Extension Act of 2010.” This law extends through May 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 March 31, 2010.  The law is retroactive to April 1, 2010.  Consequently, effective immediately, claims with dates of service April 1 and later, which were being held by Medicare contractors, are being 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).

CMS Announces Problems with Medicare Claims Crossover to Secondary Payers

On Feb. 17, 2010, CMS has identified a problem where claims were not automatically crossing over to secondary payers even though the provider remittance advice indicated otherwise.  This problem began January 5, 2010. 

Action is required on behalf of Part B professional providers where a remittance advice with an issue date between January 5, 2010, and February 12, 2010, has two or more service lines for a beneficiary where both of the following apply:

  • One service line is 100 percent reimbursable (i.e., the approved amount and amount to be paid are equal,) AND
  • One service line where part of or the entire Medicare approved amount is applied to the Part B deductible and/or carries co-insurance amounts. 

CMS is not able to forward these beneficiary claims to supplemental payers even though the remittance advice may indicate otherwise.  Providers will need to identify these claims by reviewing their remittance advice with an issue date between January 5, 2010, and February 12, 2010, that contain the criteria noted above.  Once identified, providers will need to take action to balance bill the beneficiary’s supplemental payer.  As of February 12, 2010, this system problem was fixed and all claims are crossing over to supplemental payers as indicated on the provider remittance advice.

CMS has already notified supplemental payers of these issues. This information courtsy os the ASA Washington office.