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% |
May
19
2010
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
Apr
29
2010
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
Apr
16
2010
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).
Apr
15
2010
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.
Apr
15
2010
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.
Apr
14
2010
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.
Apr
8
2010
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
Mar
26
2010
The Senate has adjourned for its two-week “Spring District Work Recess” without approving H.R. 4851, a short-term measure that would have extended the freeze on Medicare’s current physician payment rates through April 30. Several Senate Republicans led by Tom Coburn of Oklahoma objected to classifying the bill, which also included extensions of unemployment benefits and COBRA insurance, as emergency spending. The House of Representatives passed the bill on March 17. By law, the 21.3 percent cut to Medicare physician payments will take effect April 1.
CMS has instructed its contractors (Palmetto) to hold claims for services after April 1 to be held for the first 10 business days of April. They state the “hold” 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 for paper claims) after the date of receipt.
The Senate will return on April 12, from Spring Recess, which will mean they have two days to pass the bill to extend the freeze on preventing the 21% cut in Medicare. If you are so inclined an E-mail to our Senators might not hurt, http://feinstein.senate.gov -or- http://boxer.senate.gov/en/contact