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CMS Issues Announcement Regarding Claims Payments Pending Congressional Action on SGR

Wednesday, December 19, 2012

Today, the Centers for Medicare & Medicaid Services (CMS) released a statement indicating its plans should Congress fail to act to prevent cuts to Medicare physician payments that are scheduled to take effect on January 1, 2013.

On January 1, a 27 percent cut to Medicare physician payments will be triggered unless Congress takes action to pass a patch or "doc fix" averting the implementation of the Sustainable Growth Rate (SGR) mandated cut. Congressional leaders have indicated that they will not move a separate "patch" to address the SGR payment cut until they have resolved the issues associated with  the "fiscal cliff," a combination of spending and revenue measures scheduled to expire at or around January 1.  The White House and Congressional leadership are currently engaged in negotiations seeking agreement on a path forward to avert the "fiscal cliff."  

CMS notified providers of its legal obligation to pay electronic clean claims within 14 days of receipt. This suggests that CMS does not have to begin processing claims immediately on January 1.  The agency indicated that additional information about whether it will hold claims and/or require reprocessing of claims in the event Congress does act to fix the SGR will be forthcoming on or before Friday, January 11 – the date at which CMS must implement changes to their processing system.

ASA is urging members to take immediate action to prevent the SGR and sequestration payment cuts to physicians. 

The full announcement was provided by e-mail and is not yet available online.  A copy of the CMS announcement is available below:

"Attention Health Professionals: Information Regarding the 2013 Medicare Physician Fee Schedule

The negative update of 27 percent under current law for the 2013 Medicare Physician Fee Schedule is scheduled to take effect on January 1, 2013.

Medicare Physician Fee Schedule claims for services rendered on or before December 31, 2012, are unaffected by the 2013 payment cut and will be processed and paid under normal procedures and time frames.

The Administration is disappointed that Congress has failed to pass a solution to eliminate the sustainable growth rate (SGR) formula-driven cuts, and has put payments for health care for Medicare beneficiaries at risk.  We continue to urge Congress to take action to ensure these cuts do not take effect. Given the current progress with the legislation, CMS must take steps to implement the negative update.

Under current law, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt.  CMS will notify you on or before January 11, 2013, with more information about the status of Congressional action to avert the negative update and next steps."

 

 

 

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