ALERT

Medicare reimbursement cuts delayed

Friday afternoon’s Medigram Alert reported that the Senate failed to prevent the 10.6 percent cut to physician reimbursement for Medicare. On Friday evening the Centers for Medicare and Medicaid Services (CMS) notified Congress that CMS would instruct its billing contractors to “not process any physician and non-physician practitioner claims for the first 10 business days of July,” to allow for any potential Congressional solution to the 10.6 percent Medicare physician reimbursement cut set to take effect tomorrow, July 1. CMS’ e-mail notification which was sent to Congress follows:

Subject: Hill Notification: CMS Actions on Processing of Physician Claims

U.S. House and Senate Notification

Friday, June 27, 2008 (sent at 7:09 p.m.)

To: Senate Finance Committee, House Ways and Means Committee, House Energy and Commerce Committee, House and Senate Appropriations Committees, House and Senate Budget Committee, and Other Interested Hill Staff

From: Elizabeth P. Hall Director, Office of Legislation Centers for Medicare & Medicaid Services

Re: CMS Actions on Processing of Physician Claims

We apologize for sending a notification this late in the day on a Friday before a Congressional recess. However, we have received numerous questions throughout the day regarding how we will handle physician claims in the coming days. Therefore we want to share the following information as soon as possible.

To the extent possible, CMS wants to work with Congress, health care providers and the beneficiary community to avoid any disruption in the delivery and payment of physician and non-physician practitioner services beginning on July 1. In this regard, the agency plans to instruct its contractors to not process any physician and non-physician practitioner claims for the first 10 business days of July. Under current law, electronic claims are not to be paid any sooner than 14 days (29 days for paper claims) and not later than the 30th day they are submitted (otherwise, CMS must pay interest on those claims). By holding claims for health care services that are delivered on or after July 1, CMS will not be making any payments on the 10.6 percent reduction until July 15, at the earliest. Meanwhile, all claims for services delivered on or before June 30 will be processed and paid in regular order.

In addition to the temporary hold on July claims, CMS is considering additional actions the agency can take to address other expiring Medicare and Medicaid provisions. We should be able to provide you with a complete list of those actions on Monday.

We will continue to keep you informed regarding any additional action CMS might take with regard to physician claims or other July 1 expirations.

Again, we apologize for the late hour of this notification.

Stay tuned to the Society's Medigram for continuing news on the Medicare situation. For a story recapping the turmoil on the U.S. Senate floor last Thursday, read this Washington Post article. If you wish to contact your members of Congress at their Washington, D.C. offices, use the AMA’s Legislative Hotline (note that most members of Congress are in their local districts during the July 4 recess, returning to the Capitol July 7): 800.833.6354.

For more information, contact Mark Grapentine.