Physician Reimbursement Bill Signed; CMS to Continue Claims Hold
On June 25, 2010, President Obama signed into law the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010.” This law establishes a 2.2 percent update to the Medicare Physician Fee Schedule (MPFS) payment rates retroactive from June 1 through November 30, 2010. The Centers for Medicare & Medicaid Services (CMS) has directed Medicare claims administration contractors to discontinue processing claims at the negative update rates and to temporarily hold all claims for services rendered June 1, 2010, and later, until the new 2.2 percent update rates are tested and loaded into the Medicare contractors’ claims processing systems. Effective testing of the new 2.2 percent update will ensure that claims are correctly paid at the new rates. We expect to begin processing claims at the new rates no later than July 1, 2010. Claims for services rendered prior to June 1, 2010, will continue to be processed and paid as usual.
Claims containing June 2010 dates of service which have been paid at the negative update rates will be reprocessed as soon as possible. Under current law, Medicare payments to physicians and other providers paid under the MPFS are based upon the lesser of the submitted charge on the claim or the MPFS amount. Claims containing June dates of service that were submitted with charges greater than or equal to the new 2.2 percent update rates will be automatically reprocessed. Affected physicians/providers who submitted claims containing June dates of service with charges less than the 2.2 percent update amount will need to contact their local Medicare contractor to request an adjustment. Submitted charges on claims cannot be altered without a request from the physician/provider.
Physicians/providers should not resubmit claims already submitted to their Medicare contractor.
Another Bandaid for the SGR issue
The House of Representatives just passed the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 (H.R. 3962) by a vote of 417 to 1. This legislation contains provisions that block the 21.3 percent cut to Medicare physician payments until Nov. 30. The Senate passed identical legislation late last week. The president is expected to sign the bill into law shortly. Practices will then see a 2.2 percent increase to Medicare physician payment for claims with dates of service from June 1 through Nov. 30.
Why can’t the Obama Administration get this right and fix the underlying reimbursement problems asociated with the SGR? With the large number of uninsured that will now be insured under the new Obamacare plan we will need all healthcare providers, MDs, RNs, PAs, etc. in the sytem and productive to meet the increased demand anticipated. Any reimbursement changes that have the impact that the SGR could, would drive providers out of the sytem in great numbers. Let’s fix the SGR problem once and for all.
