And so it begins ... Medicare claims pay out today, fees cut 21 percent
With half of the year behind us, the Medicare Physician Fee Schedule for 2010 still hangs in limbo. This afternoon, the Senate voted to delay the cut another six months, but the cut is still in place until the U.S. House of Representatives acts.
In response to Congressional inertia, CMS had issued guidance to the Medicare contractors on June 14 to continue holding claims with dates of service June 1 or later until Friday, June 18. So starting today, your claims for dates of service June 1 or later will be paid at the 21-percent reduced rate – and likely reprocessed later if Congress makes an updated fee schedule retroactive to June 1.
Hopefully the Congressional action will take place next week but in the meantime, your practice must determine if and how this affects your day-to-day operations. If you have a significant Medicare and Tricare patient population, you may need to assess your options for maintaining a workable cash flow and perhaps making some temporary cut backs in expenses:
- Are there any planned purchases that can be delayed?
- Can you schedule more procedures and ancillary services to offset the lost revenue?
- Would a push to clean-up outstanding accounts receivables make a difference?
- Can you limit the number of non-urgent Medicare and Tricare patients seen in the next few weeks to bring in more patients whose plans pay higher fees?
These disruptive and disheartening delays take away from your practice's ability to focus on quality care and waste tax dollars to pay for the reprocessing of claims due to untimely legislation and the unwillingness of our Congress to develop a long-term solution to this broken payment methodology. Help keep this issue in front of the Congressional representatives through AAFP Speak Out. Download and share this patient information piece about the broken Medicare physician payment system by placing copies in your waiting and exam rooms.
Stay tuned. Good, bad, or more of the same, we'll keep the reports coming. In the meantime, keep in mind this quote often attributed to Mark Twain: "No man's life, liberty, or property is safe while the legislature is in session." Things haven't changed much in 150 years, have they?
Free ICD-10 teleconference June 15th
The Centers for Medicare & Medicaid Services (CMS) is working to bring together physicians, payers and electronic systems/service vendors to make the dreaded transition to the ICD-10 diagnosis code set smoother than past HIPAA-required changes. A consistent message in ICD-10 communications from CMS: There will be no delay in implementation. You must be ready and able to bill with ICD-10 codes on Oct. 1, 2013.
To effect this smooth transition, CMS has participated in educational summits and recently hosted a conference for billing services, software vendors and clearinghouses to discuss planning, testing and resources that can make implementing ICD-10 easier.
But what about physicians, who may ultimately suffer unpaid claims if the transition to the new codes doesn't go smoothly? You have not been forgotten. CMS will soon host a national provider conference call on "ICD-10 Implementation in a 5010 Environment" to provide you and your staff with information to use in planning for this change. Here are the details, should you or someone from your office wish to participate:
When: Tues., June 15, 2010
Time: 12 p.m. – 2 p.m. ET
Target Audience: Medical coders, physician office staff, provider billing staff, health records staff, vendors, educators, system maintainers and all Medicare fee-for-service (FFS) providers
You must register for the call. Registration will close at 12 p.m. ET on June 14, 2010, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time. You only need to register once per phone line, no matter how many individuals from your practice will be listening to the call.
To register, go to: http://www.eventsvc.com/palmettogba/061510
Fill in all required data.
Verify that your time zone is displayed correctly in the drop down box.
You will be taken to the "Thank you for registering" page and will receive a confirmation email shortly thereafter. NOTE: Please print and save the registration page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.
If assistance for hearing impaired services is needed, the request must be sent to "email@example.com" no later than 3 business day before the event.
Presentation materials for the June 15 call will be available on the CMS web site (in the "Downloads" section) no later than 24 hours before the conference call. Presentation materials from previous CMS-sponsored calls on the basics of ICD-10 are also available there. Remember to download the presentation materials prior to the call.
The AAFP is working to provide members with ICD-10 information and resources including a transition planning tool and free, members-only ICD-10 coding education modules. Check back often to find new information and resources as these will be published as developed.
2010 Medicare physician fee schedule: Here we go again!
I feel like a broken record.
On April 1 (see "2010 Medicare physician fee schedule: Stop me if you've heard this one before"), I shared with you how the Senate had again failed to pass legislation avoiding a 21 percent cut in the Medicare payment rate to physicians. As a result, the cut was technically effective with dates of service on or after April 1, 2010, but the Centers for Medicare & Medicaid Services (CMS) again instructed its contractors to hold claims for services paid under the fee schedule for the first 10 business days of April to give Congress time to rescind the cut.
It actually took 15 days. On April 15, Congress passed and the President signed legislation that extended the 2009 Medicare physicians payment rate until May 31, 2010.
Now May 31 has come and gone, and I know that you will be shocked to learn that Congress again failed to act. Actually, to be fair to the House of Representatives, it was the Senate that again failed to act. The House passed a bill on May 28 that would have increased the payment rate by 2.2 percent for the rest of 2010 plus an additional 1 percent in 2011. The Senate, however, determined that there was insufficient time to consider the bill before their Memorial Day recess and left Washington without action on the bill.
Consequently, the 21 percent cut is technically in effect again for dates of service on or after June 1. And once again, CMS has instructed its Medicare contractors to hold claims for services paid under the fee schedule for the first 10 business days of the month to give Congress time to rescind the cut.
Congress returns from its recess on June 7. What will happen then is anyone's guess. In the meantime, it's the same tune and a different verse, and it's beginning to sound like the blues to most physicians.
Want to use this article elsewhere? Get Permissions
Current Issue of FPM
Search This Blog
& aafp american_academy_of_family_physicians billing centers centers_for_medicare_&_medicaid_services centers_for_medicare_and_medicaid_services claims cms coding congress conversion_factor cpt e/m ehr electronic_health_record evaluation_and_management for icd-10 icd-9 medicaid medicare medicare_fee_schedule payment physician physician_quality_reporting_system pqrs services sgr sustainable_growth_rate
- November 2014
- October 2014
- September 2014
- August 2014
- July 2014
- June 2014
- May 2014
- April 2014
- March 2014
- February 2014
- January 2014
- December 2013
- November 2013
- October 2013
- September 2013
- August 2013
- July 2013
- June 2013
- May 2013
- April 2013
- March 2013
- February 2013
- January 2013
- December 2012
- November 2012
- October 2012
- September 2012
- August 2012
- July 2012
- June 2012
- May 2012
- April 2012
- March 2012
- February 2012
- January 2012