2010-03-01

The March 1 deadline to enact legislation preventing the 21 percent reduction in Medicare physician payment has passed without legislative action. Although the House of Representatives was able to pass legislation on February 25 that provided a month extension of the CY 2009 physician payment level, Senator Jim Bunning (R-KY) blocked action in the Senate.

Consequently, the Centers for Medicare and Medicaid Services (CMS) has announced (see below) that it has the authority to hold claims for 10 business days so that the reduction in payment will not be implemented until March 12. After that, claims would be paid with the 21 percent cut. Congress could still act after March 10 to make the payment fix, blocking the cut retroactively, but doctors would have to file new claims to recoup the lost amounts, creating a paperwork nightmare.

Meanwhile, the House and Senate are working on an alternative legislative vehicle to stop the scheduled physician payment cut and hope to pass it in the next week. The likely bill will be the Tax Extenders Act of 2009 (HR 4213), a measure that could be used to extend the physician payment freeze at 2009 levels through September 30, 2010. The Senate will begin debate on the bill on March 1. The bill may also address an extension of unemployment insurance and the health-care subsidies through the end of 2010. While it is anticipated that Democrats will be supportive of this bill, there is concern that Republicans will look for offsets to pay for these extensions.

It is critical that you contact your senators and representative now to stop the 21 percent physician payment cut.

Announcement From CMS

The Centers for Medicare & Medicaid Services (CMS) is working with Congress, health-care providers, and the beneficiary community to avoid disruption in the delivery of health-care services and payment of claims for physicians, non-physician practitioners, and other providers of services paid under the Medicare physician fee schedule (MPFS). As you are aware, the Department of Defense Appropriations Act of 2010 provided a zero percent (0%) update to the 2010 MPFS effective for dates of service January 1, 2010, through February 28, 2010.

We believe Congress is working to avoid the negative update that will take effect March 1. Consequently, CMS has instructed its contractors to hold claims containing services paid under the MPFS for the first 10 business days of March. The holding of MPFS claims will only affect claims with dates of service March 1, 2010, and forward. This hold should have a minimum impact on provider cash flow because, under current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt. Be on the alert for more information about the 2010 Medicare Physician Fee Schedule Update.