CMS to Begin Processing Claims With 2.2 Percent Increase
The AMA received the following message from the Centers for Medicare and Medicaid Services (CMS) today regarding the details of Medicare claims processing under the new law.
"On June 25, 2010, President Obama signed into law the ‘Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010.’ This law establishes a 2.2 percent update to the Medicare Physician Fee Schedule (MPFS) payment rates retroactive from June 1 through Nov. 30, 2010.
The Centers for Medicare and Medicaid Services (CMS) has directed Medicare claims administration contractors to discontinue processing claims at the negative update rates and to temporarily hold all claims for services rendered June 1, 2010, and later, until the new 2.2 percent update rates are tested and loaded into the Medicare contractors’ claims processing systems. Effective testing of the new 2.2 percent update will ensure that claims are correctly paid at the new rates. We expect to begin processing claims at the new rates no later than July 1, 2010. Claims for services rendered prior to June 1, 2010, will continue to be processed and paid as usual.
"Claims containing June 2010 dates of service which have been paid at the negative update rates will be reprocessed as soon as possible. Under current law, Medicare payments to physicians and other providers paid under the MPFS are based upon the lesser of the submitted charge on the claim or the MPFS amount. Claims containing June dates of service that were submitted with charges greater than or equal to the new 2.2 percent update rates will be automatically reprocessed. Affected physicians/providers who submitted claims containing June dates of service with charges less than the 2.2 percent update amount will need to contact their local Medicare contractor to request an adjustment. Submitted charges on claims cannot be altered without a request from the physician/provider. Physicians/providers should not resubmit claims already submitted to their Medicare contractor."
President signs six-month Medicare patch; delaying SGR mess Congress created is not a solution
On June 24, the U.S. House of Representatives passed H.R. 3962, the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010.” This piece of legislation includes provisions to replace the 21 percent Medicare physician payment cut that took effect at the beginning of June with a 2.2 percent payment update that will extend through November 2010.
The legislation was passed by a bipartisan vote of 417-1, with Rep. George Miller, D-Calif., casting the lone dissenting vote. Miller chairs the House Committee on Education and Labor, and objected to pension-related provisions of H.R. 3962 that were added without his consent and used as an offset for the bill’s $6.4 billion cost. Because an identical version of the bill passed the U.S. Senate last week, it was sent quickly to President Obama who signed it into law today, on June 25.
AMA President Cecil B. Wilson, MD, issued a statement on June 24 emphasizing the need for a permanent fix—with a 23 percent Medicare physician payment cut to come in December, increasing to nearly 30 percent in January.
“Congress is playing a dangerous game of Russian roulette with seniors’ health care,” Dr. Wilson said. “Sick patients can’t wait. Congress must replace the broken payment system before the damage is done and cannot be reversed.”
In a statement of support issued by the White House after the bill passed, President Obama noted, “I believe we need to permanently reform the Medicare formula in a way that attacks our fiscal problem without punishing our hard-working doctors or endangering the benefits on which so many of our seniors rely. I look forward to working with Congress to achieve that goal…”
Many members of Congress expressed similar views during the debate, echoing the AMA’s strongly held conviction that short-term reprieves that make future cuts more severe and that increase the cost of permanently repealing Medicare’s sustainable growth rate (SGR) formula are not the solution.