News From CMS
Claims Paid Under the Medicare Physician Fee Schedule
To the extent possible, the Centers for Medicare & Medicaid Services
(CMS) is working with Congress, health care providers, and the
beneficiary community to avoid disruption in the delivery of health care
services and payment of claims for physicians, non-physician
practitioners, and other Fee-For-Service (FFS) providers of services
paid under the Medicare physician fee schedule, beginning July 1. In
this regard, CMS has instructed its contractors to hold these claims for
the first 10 business days of July, for dates of service in July. This
should have minimum impact on provider cash flow because, under current
law, electronic claims are not paid any sooner than 14 days (29 days for
paper claims) after the date of receipt. Meanwhile, all claims for
services delivered on or before June 30 will be processed and paid under
normal procedures.
After 10 business days, contractors will begin releasing claims into
processing under the fee schedule which implements current law. This,
of course, could result in claims being processed with the negative 10.6
percent update. If a new law is enacted which changes the negative 10.6
percent update, retroactive to July 1, CMS is prepared to automatically
reprocess most of those claims which have already been processed.
Under the Medicare statute, Medicare pays the lower of submitted charges
and the Medicare fee schedule amount. Claims with dates of service July
1 and later billed with a submitted charge at least at the level of the
January 1-June 30, 2008, fee schedule will be automatically reprocessed
if Congress retroactively reinstates the update that was in effect for
that time period. Any lesser amount will likely require providers to
re-submit a revised claim.
To the extent possible, providers may hold claims in-house until it
becomes clearer as to whether new legislation will be enacted or until
cash flow becomes problematic. This will reduce the need for providers
to reconcile two payments (i.e., the initial claim and the reprocessed
claim), and it will simplify provider billings of beneficiary
coinsurance and payment calculations for payers which are secondary to
Medicare.
In addition, be on the alert for more information about other
legislative provisions which may affect Medicare FFS providers.
