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.
http://www.californiahealthline.org/articles/2010/5/28/house-dems-make-more-cuts-to-extenders-bill-vote-planned-for-friday.aspx
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% |
| |
|
|
|
|
|
| |
|
|
|
|
|
| |
|
|
|
|
|
As a new June 1 deadline looms for Congressional action, Congress has yet to take action to prevent the 21% reduction in Medicare payments. Again, we are all faced with these uncertain times of how will we be paid for services provided to the Medicare patient. It is hard to imagine that Congress will not extend the current fee schedule and again delay the 21% cut in payments.
The biggest issue I have read on why Congress has not been able to pass a longer or more permanent fix to the Medicare payment system is the additional cost that is estimated at $330 to $374 billion dollars if a permanent repeal of the current Medicare fee scheduled is passed.
I will keep you updated as I learn more and as June 1, quickly approaches. As I mentioned in previous articles calling your Congress person wouldn’t be a bad idea and express our frustrations with the handling of your Medicare reimbursements.
Talk to you soon,
Bob
MMS Updates, Medical News | bsayers May 28, 2010 | 
Comments (0)