Senate May Delaying 21.2% Physician Payment Cut

Senators are discussing delaying the pending 21.2 percent cut to Medicare physician payments for an additional 15 or 30 days. The extension of the current freeze would likely be included in an “extenders” bill, which would address COBRA, unemployment insurance, the Patriot Act, and highway funding provisions which are also scheduled to expire on Feb. 28. Consideration of this legislation may take place as early as today.

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.