On December 19, the President signed into law H.R. 3326, the "Department of
Defense Appropriations Act, 2010," Click here to see the entire bill, click here for the press release, which includes a zero percent Medicare physician update through February 28,
2010.
This action staves off a 21% pay cut for physicians scheduled for
January 1, 2010. Congress will continue to work in the new year on a physician
fee schedule fix to extend beyond the new February 28 deadline.
In anticipation of the two-month freeze of Medicare payments to physicians,
the Centers for Medicare and Medicaid Services (CMS) also instructed its
contractors to hold claims for the first 10 business days of January for 2010
dates of service. A copy of the transmittal is below.
____________________________________________________________________________
Information Regarding the Holding of Claims
for Services Paid Under the 2010 Medicare Physician Fee
Schedule
To the extent possible and in consideration of
possible legislative changes, 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, beginning
January 1, 2010.
In this regard, CMS has instructed its contractors to hold
claims containing services paid under the Medicare Physician Fee Schedule (MPFS)
for the first 10 business days of January (January 1 through January 15) for
2010 dates of service. This should have minimum impact on provider cash flow
because, under current law, clean electronic claims are not paid any sooner than
14 calendar days (29 days for paper claims) after the date of receipt.
Meanwhile, all claims for services delivered on or before December 31, 2009,
will be processed and paid under normal procedures.
After 10 business days, contractors will begin
releasing held claims into processing under the fee schedule which implements
current law. This, of course, could result in claims being processed with the
negative 21.2% update. If a new law is enacted which changes the
negative update effective January 1, CMS will correctly process claims under the
new law and, if necessary, CMS is prepared to automatically reprocess most of
those claims which have already been processed at the lower rate.
Under the Medicare statute, Medicare payments to
physicians and other affected providers are based upon the lesser of the actual
charge or the MPFS amount. Providers who submit charges that are greater than
the negative 2010 MPFS will automatically have their claims reprocessed.
Physicians who submit charges that are equal to or less than the 2010 MPFS
amount will need to request an adjustment. Submitted charges on claims cannot be
altered without a request from the physician/provider.
To the extent possible, providers may hold claims
in-house until it becomes clearer as to whether new legislation will be enacted
or until cash flow becomes problematic. This will reduce the need for providers
to reconcile two payments (i.e., the initial claim and the reprocessed claim),
and it will simplify provider billings of beneficiary coinsurance and payment
calculations for payers which are secondary to Medicare.
CMS has extended the 2010 Annual Participation
Enrollment Program end date from January 31, 2010, to March 17, 2010- therefore, the enrollment period now runs
from November 13, 2009, through March 17, 2010.
The effective date for any Participation status
change during the extension, however, remains January 1, 2010, and will be in
force for the entire year.
Contractors will accept and process any
Participation elections or withdrawals, made during the extended enrollment
period that are received or post-marked on or before March 17,
2010.
In addition, be on the alert for more information
about other legislative provisions which may affect you.
President Signs into Law H.R. 3326, Department of Defense Appropriations Act, 2010: Includes a 0% Medicare Physician Update through February 28, 2010
