American Society of Hematology

Medicare Announces Mandatory Payment Reductions in the Fee-for-Service (FFS) Program For Claims Beginning April 1

Published on: March 08, 2013

Because the Congress was unable to reach an agreement on deficit reduction by March, by law automatic, across-the-board spending cuts known as "sequestration" have been triggered. The Centers for Medicare and Medicaid Services (CMS) has announced that Medicare FFS claims with dates-of-service or dates-of-discharge on or after April 1, 2013, will incur a two percent reduction in Medicare payment. Claims for durable medical equipment (DME), prosthetics, orthotics, and supplies, including claims under the DME Competitive Bidding Program, will be reduced by two percent based upon whether the date-of-service, or the start date for rental equipment or multi-day supplies, is on or after April 1, 2013.

The claims payment adjustment shall be applied to all claims after determining coinsurance, any applicable deductible, and any applicable Medicare Secondary Payment adjustments.

Though beneficiary payments for deductibles and coinsurance are not subject to the two percent payment reduction, Medicare's payment to beneficiaries for unassigned claims is subject to the two percent reduction. The Centers for Medicare & Medicaid Services encourages Medicare physicians, practitioners, and suppliers who bill claims on an unassigned basis to discuss with beneficiaries the impact of sequestration on Medicare's reimbursement.

ASH continues to advocate for appropriate and stable Medicare physician reimbursement. Clinicians are strongly encouraged to join the Society's on-line advocacy campaign urging Congress to repeal the current payment formula and to find a balanced approach to deficit reduction.

Specific questions about reimbursement should be directed to your Medicare claims administration contractor.

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