Bobs Blog

MMS June 2010 Client Alert

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

Congress stops the 21% reduction in Medicare fees

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.

Congress continues debate on Medicare physician payments; cut still in effect

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

Senate unable to pass 6-month Medicare payment provision; CMS to now begin processing held claims at -21.3%

 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

CMS extends Medicare claims processing hold through June 17

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.