Jul
15
2010
The new Medicare Rates have been published and are available on the Medicare Web Site. Below is a link to a sampling of the top E+M Codes you most commonly use to compare the three different rates we have been paid for these codes this year, 2010, by Medicare. If you are interested in receiving a complete copy of the new Medicare Fee Schedule, respond to this article by the link provided and I will forward you the Medicare Fee Schedule.
Jul
9
2010
I am happy to report that over the last two days several of our client accounts have started to receive Medicare payments for June dates of service. Please be on the look out for Medicare making direct deposits in your bank accounts if you receive Medicare funds by EFT. We did notice that the dates of service Medicare is paying are not always the first batches we sent to Medicare, therefore we will be monitoring very closely the batches that have not been paid for June and make sure they do not get missed by Medicare.
Jul
2
2010
Our Medical Billers at Medical Management Strategies, LLC, (MMS) have been in contact with Medicare daily and as of today, July 2, 2010, we have the following to report. We have been told by the Medicare Customer Service Department, that June Dates of Service Claims began being processed, yesterday, July 1, 2010. Many of our clients have large amounts of claims in the pending to be paid status in the Medicare payment system. If you are interested in knowing how many claims and the dollar value of those claims in the pending status please call the medical biller at MMS who handles your account and we will be glad to provide to you that information. We are not able to get an exact date of when you will receive the payments for these claims but we have been told that it will be within the next 14 days, so by July 15, 2010, is what we have been told.
Jun
28
2010
The June 2010 Client Alert is now available for review.
Topics included Pecos enrollment deadlines, Medicare advantage marketing changes, and the latest update on Medicare reimbursements.
-Bob
Jun
25
2010
The President Signs the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 — 2.2 Percent Medicare Physician Fee Schedule Update for June 1, 2010, Through November 30, 2010
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.
Please be aware that we will experience very little Medicare payments the first half of July 2010, while our Medicare Contractor, Palmetto, begins reprocessing claims at the new fee schedule. I am sure it will also take some time before we see the claims already paid at the 21% decrease reprocessed, as I am sure until the back log is cleaned up Palmetto will not begin cleaning up this issue.
Jun
23
2010
Despite action by the Senate late last week, the House of Representatives still has not scheduled a vote for legislation addressing the 21.3 percent cut to Medicare physician payments that has been in effect since June 1. As a result of Congress’ inability to address these cuts, Medicare contractors were authorized last Friday to begin processing held claims at the reduced rate.
Please contact your local House of Representative and ask them to please urge there colleagues to push the legislation through before the physicians can no longer provide the Medicare patients services because of financial losses.
Lois Capps
Santa Barbara
301 E. Carrillo Street, Suite A
Santa Barbara, CA 93101
Phone: (805) 730-1710
Fax: (805) 730-9153
To send e-mail go to: http://capps.house.gov/send-an-email.shtml
Jun
18
2010
The Senate was unable to pass the American Jobs and Closing Tax Loopholes Act (H.R. 4213) late Thursday night, despite reducing the length of the Medicare physician payment provision from 19 months to 6 months in order to reduce the overall cost of the bill. The legislation includes a provision calling for a 2.2 percent increase to Medicare physician payment for claims with dates of service of from June 1 through Nov. 30. Since the Senate failed to pass the bill this week, Medicare contractors may start today to process June claims at the -21.3 percent rate. The Senate is not expected to hold further votes this week.
Earlier this week, the Centers for Medicare & Medicaid Services (CMS) extended the Medicare claims processing hold through June 17. CMS and the Office of Inspector General are expected to release guidance on medical practices’ responsibilities regarding limiting charges and patient co-pay requirements as impacted by the Medicare payment cuts as well as the geographic payment adjustments called for by the recently enacted healthcare reform law soon.
I would encourage you to call your Senator immediately and voice your concern over the Senates inability to act on this very critical issue. Remind them that their method of handling this issue to date, is not in the best interest of the American people who they serve and has and will continue to cause extreme financial hardship on you and your colleagues to the point of financial jeopardy, if this continues any longer. We need the Senate to stop the politics and begin making decisions on this issue that are financially responsible to us the physicians and in turn doing what is right for the American people.
Sen. Dianne Feinstein
San Francisco – Main District Office
1 Post St
San Francisco, CA 94104-5240
Phone: 415-393-0707
Fax: 415-393-0710
Sen. Barbara Boxer
San Francisco – Main District Office
1700 Montgomery St
San Francisco, CA 94111-1023
Phone: 415-403-0100
Fax: 202-224-0454
Jun
14
2010
This morning the Centers for Medicare & Medicaid Services released the following announcement:
The Continuing Extension Act of 2010, enacted on April 15, 2010, extended the zero percent (0%) update to the 2010 Medicare Physician Fee Schedule (MPFS) through May 31, 2010. At this time, Congress is debating the elimination of the negative update that took effect June 1, 2010. The Centers for Medicare & Medicaid Services (CMS) is hopeful that Congressional action will be taken within the next several days to avert the negative update.
To avoid disruption in the delivery of health care services to beneficiaries and payment of claims for physicians, non-physician practitioners, and other providers paid under the MPFS, CMS had instructed its contractors on May 27th to hold claims for services paid under the MPFS for the first 10 business days of June (i.e., through June 14, 2010). This hold only affects MPFS claims with dates of service of June 1, 2010, and later.
Given the possibility of Congressional action in the very near future, CMS is now directing its contractors to continue holding June 1 and later claims through Thursday, June 17, lifting the hold on Friday, June 18.
This action will facilitate accurate claims processing at the outset and minimize the need for claims reprocessing if Congressional action changes the negative update. It also should minimize the provider and beneficiary burdens and costs associated with reprocessing claims.
We understand that the delayed processing of Medicare claims may present cash flow problems for some Medicare providers. However, we expect that the delay, if any, beyond the normal processing period will be only a few days. Be on the alert for more information regarding the 2010 Medicare Physician Fee Schedule Update.
May
28
2010
Congress has not yet passed legislation to stop the 21% Medicare payment cut due on June 1. Medicare has announced a 10 business day hold on claims with dates of service June 1 forward, if Congress does not pass new legislation by June 1 to delay the 21% payment cut. The House is currently working on a new bill to stop the 21% cut for at least a couple of years, but there is still a lot of unrest about the new bill in both the House and Senate. See link below on article about the new bill.
May
26
2010
The Medicare Fee Schedule is changing again. This change has nothing to do with the 21% decrease we have been discussing which is still up in the air and needs to be decided by June 1, 2010 or we will be in a Medicare holding pattern for 10 business days again. This new change is because of the heatlhcare reform regulations that recently passed in March 2010. It seems that some of the regulations passed in March 2010 has implications of changing Medicare reimbursements. I am including with my Blog a Medicare fee schedule spreadsheet to provide you with the changes by top CPT Codes you all use. The fees in this spreadsheet are for the Central Coast of California area, other areas of the country will have different fees. These changes are retro back to January 1, 2010, and this was all put into place on May 19, 2010. The following is what CMS (Medicare) posted on their Web Site:
Jurisdiction 1 Part B
Medicare Physician Fee Schedule: Implementation of the Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act of 2010
On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act. One week later, on March 30, the President also signed into law the Health Care and Education Reconciliation Act of 2010. These two new laws have a significant impact on the Medicare program and many of the provisions have effective dates prior to this point in time. Over the past several weeks, the Centers for Medicare & Medicaid Services (CMS) has begun implementing various provisions of the new laws, including those with past effective dates. In addition to implementing these legislative changes, the Medicare Physician Fee Schedule is being updated to include certain corrections, retroactive to January 1, 2010, as prescribed in recently published notices in the Federal Register.
Once Medicare contractors have the new payment files in place, per the above, all claims going forward will be processed at the revised rates.
However, we continue to work on the best way to address the many claims that are paid at the rates that were in place before the current corrections and updates are made. Please be on the alert for further information about how CMS will address past claims. Until then, providers should NOT resubmit previously-processed claims affected by the payment changes, as it is likely that these resubmissions may be denied as duplicate claims.
| 2010 Revised Medicare Rates – 5/19/2010 | SLO County | ||||
| CPT Codes | Description | January 1, 2010 | May 19, 2010 | Difference | % difference |
| 99201 | New pt office visit | 39.80 | 39.79 | (0.01) | -0.03% |
| 99202 | New pt office visit, expanded | 68.58 | 68.37 | (0.21) | -0.31% |
| 99203 | New pt office visit, detailed | 99.01 | 99.00 | (0.01) | -0.01% |
| 99204 | New pt office visit, comprehensive | 152.93 | 153.11 | 0.18 | 0.12% |
| 99205 | New pt office visit, complex | 192.07 | 192.04 | (0.03) | -0.02% |
| 99211 | Est. pt office visit | 19.72 | 19.72 | 0.00 | 0.00% |
| 99212 | Est. pt office visit, prob focused | 39.80 | 39.79 | (0.01) | -0.03% |
| 99213 | Est. pt office visit, detailed | 66.78 | 66.39 | (0.39) | -0.58% |
| 99214 | Est. pt office visit, comprehensive | 99.99 | 99.40 | (0.59) | -0.59% |
| 99215 | Est. pt office visit, complex | 134.59 | 133.99 | (0.60) | -0.45% |
| 99221 | Initial hosp, low complexity | 94.87 | 94.85 | (0.02) | -0.02% |
| 99222 | Initial hosp, moderate complexity | 129.12 | 128.91 | (0.21) | -0.16% |
| 99223 | Subsequent hosp, high complexity | 190.04 | 190.21 | 0.17 | 0.09% |
| 99231 | Subsequent hosp, low complexity | 38.33 | 37.95 | (0.38) | -0.99% |
| 99232 | Subsequent hosp, moderate complexity | 69.08 | 68.87 | (0.21) | -0.30% |
| 99233 | Subsequent hosp, high complexity | 99.09 | 98.88 | (0.21) | -0.21% |