CMS Directs Carriers to Process Claims with the 21 Percent Cut

Immediately following Senate passage of the 6-month “doc fix,” CMS released information informing lawmakers that carriers have been directed to process claims for services provided on June 1 and later with the 21 percent cut. CMS Indicated that once a payment fix is enacted into law, they are “prepared to act expeditiously to make the appropriate changes to Medicare claims processing systems.”

U.S. House and Senate Notification
Friday, June 18, 2010

To: Congressional Health Staff

Re: The 2010 Medicare Physician Fee Schedule

The Continuing Extension Act of 2010, enacted on April 15, 2010, extended the zero percent update to the 2010 Medicare Physician Fee Schedule (MPFS) through May 31, 2010.

On May 27, 2010, the Centers for Medicare & Medicaid Services (CMS) initially instructed contractors to hold claims for services paid under the MPFS for the first 10 business days of June. On June 14, CMS extended this hold for an additional three business days (i.e., through June 17, 2010). This hold only affected MPFS claims with dates of service of June 1, 2010 and later.

The CMS today directed contractors to lift the hold and begin processing June 1 and later MPFS claims under the law’s negative update requirement. Held claims will be released and processed on a flow basis, first-in/first-out.

Congress continues to debate the elimination of the negative update that took effect June 1, 2010. The CMS is hopeful that Congressional action will be taken to avert the negative update. We continue to monitor Congressional actions, and if Congress changes the negative update that is currently in effect, we are prepared to act expeditiously to make the appropriate changes to Medicare claims processing systems.

ASA Member, Norman A. Cohen, M.D., speaks about the SGR issue on Oregon Public Broadcasting (mp3 file)