Palmetto started releasing claims but will we ever see the money!

As my previous articles stated, Congress and the President did pass and sign the bill to NOT reduce the Medicare Fee schedule by 21% and for Palmetto (Medicare Intermediary) to begin releasing claims and paying for claims with dates of service April 1, 2010 to present on April 15, 2010.  The question remains will we ever see the money for these claims.  As of this date, April 29, 2010, we have seen very little payments for April dates of service claims.  Many of you have very large amounts of dollars sitting on what is called the Medicare payment floor, waiting to be paid to you.  We have called Palmetto and they tell us it is because of the large back log of claims from the 10 day hold.  It is hard to pay the bills with that type of an answer.  We will continue to push and call and shout and scream with Palmetto to get our clients paid but I wanted you to know this is occuring.  If you would like to help us push and call, etc. the customer service number at Palmetto is 866-931-3901.

-Bob

categories MMS Updates, Medical News | bsayers April 29, 2010 | comments Comments (0)

President signs extension bill, Medicare physician payment freeze now to occur May 31

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).

categories Medical News | bsayers April 16, 2010 | comments Comments (0)

CMS (Medicare’s) Instruction on Paying Submitted Claims

CMS continues to work with Congress towards possible legislative action to extend the zero percent update for the Medicare Physician Fee Schedule.  The zero percent update expired on March 31, 2010.

We are hopeful that Congress will take action in the next few days.

Until now, CMS has been holding April 2010 date-of-service claims, anticipating congressional action.  But that has not occurred.

Therefore, under current law, Medicare contractors will begin processing claims with dates of service April 1 and later at the negative update rates.  This will begin as soon as systems are fully tested to ensure proper claims payment.  And, Medicare contractors will pay these claims on a first in – first out basis.

If subsequent congressional action extends the zero percent update retroactive to April 1, 2010, Medicare will reprocess those claims at the higher rates.  Claims with submitted charges at or above the higher rates will be able to be automatically reprocessed without further action.

Claims with dates of service prior to April 1, 2010, are not affected and will continue to be processed under normal procedures at the rates in effect on the date of service.

categories Medical News | bsayers April 15, 2010 | comments Comments (0)

Senate fails to approve payment freeze extension

Earlier this evening, the Senate failed to approve an amended version of H.R. 4851, the Continuing Extension Act of 2010, legislation which would continue the payment freeze at its current level through June 1. As a result of the Senate’s failure to pass identical legislation addressing the extension of the Medicare physician payment freeze, Medicare contractors will begin processing claims on Thursday, April 15. The Senate is expected to return to consideration of this amended version of H.R. 4851 today.

Since the version of the extension legislation the Senate is considering is not identical to the version passed by the House on March 17, the House must approve this Senate passed version before sending it to the president for his signature. Earlier yesterday, the House Rules Committee approved a rule allowing for swift consideration of this amended version of H.R. 4851. The House is expected to act on this legislation later this week.

The Centers for Medicare and Medicaid Services (CMS) previously indicated that if legislation was not enacted by midnight April 14, Medicare contractors would begin processing the held April 1 claims. Once final legislation regarding the Medicare payment freeze is passed, we anticipate CMS issuing an official statement.

categories MMS Updates, Medical News | bsayers | comments Comments (0)

Looming Medicare Pay Cuts May Be Unavoidable, Says AAFP

A leading primary care physicians association is warning its members that Congress, bogged down by partisan squabbling, may not be able to delay the 21.2% cuts to Medicare reimbursements that go into effect Thursday.

“The physician payment extension has been caught up in much larger issues of unemployment insurance and the federal deficit,” Kevin Burke, lead lobbyist for the American Academy of Family Physicians, said in a media release. “But while Congress is mired in its partisan battles, family physicians are faced with drastically reduced payments now and administrative nightmares in the near future.”

The Senate today passed a procedural hurdle on a bill that would provide a Medicare payment extension through April 30, reversing the 21.2% reduction that took effect on April 1 under the sustainable growth rate formula.

Now, Senators will begin consideration of the bill reversing the payment reduction. If Senators don’t agree to shorten the allocated debate time, however, they may not vote on final passage of the bill until after Thursday’s deadline, Burke said.

The physician pay cut has been an ongoing drama on Capitol Hill. The House passed the Medicare extension bill on March 17. However, the Senate failed to act on it before a two-week spring break recess on March 26. The reimbursement cut went into effect on April 1, but CMS ordered contractors (Palmetto) to hold payments delivered after April 1 for 10 business days, or April 14, anticipating that Congress would act on the cuts before they took effect.

Burke says the bill providing the payment patch through April 30 is expected to pass, perhaps by Friday, after which Congress will debate a bill to extend the current payment rate until Oct. 1. Both the House and the Senate have passed separate extension bills, but are negotiating how to pay for it.

If Congress doesn’t approve the Medicare patch until after the April 15 deadline, physicians would see one or two days of claims processed at the reduced rate. AAFP has asked CMS if it will pay the difference between the reduced claims rate and the restored rate automatically or if physicians will have to resubmit their claims. AAFP also asked for guidance on how physicians should handle copayments they may have collected since April 1.

AAFP has additionally asked CMS if the deadline for physician nonparticipation in Medicare for 2010 has passed, AAFP said.

categories MMS Updates, Medical News | bsayers April 14, 2010 | comments Comments (0)

April 2010 MMS Client Alert

Please see the link below to read the April 2010 MMS Client Alert with topics including capturing EHR bonus money, Medicare PECOS enrollment updates, office workers compensation programs and United Healthcare news.

For all of this information and more please follow the link here.

-Bob

categories MMS Updates | rloughlin April 8, 2010 | comments Comments (0)