Archive for April, 2010|Monthly archive page

Finally – A Vote On The SGR/Medicare Fee Schedule Provides A Short Reprieve, Delaying MPFS Cuts Until June 1

In Uncategorized on April 16, 2010 at 1:59 pm

Late last night (April 15th), President Obama signed into law the legislation that was finally passed by both the U.S. Senate and House of Representatives which temporarily rescinds the 21.3% SGR-related cut in Medicare Physician Fee Schedule payments that went into effect on April 1. This will in effect extend the “freeze” in fee schedule payments that had been in effect since January 1, 2010. This new freeze will extend through the end of May.  At that point, further extension, or a more permanent fix will be necessary to continue to avoid the 21.3% cut in the Medicare Physician Fee Schedule.

Earlier in the day yesterday, the Centers For Medicare and Medicaid Services (CMS) announced that they no longer had the statutory authority to delay payment of provider claims and directed their Contractors to begin processing claims starting with the oldest pending claims. However, prior to actually processing and paying these claims, the Contractors must test their system to see if the claims can process correctly. It is conceivable that this testing could take some time and by the time the Contractors complete their testing, the temporary SGR “fix” legislation will have been signed into law, thereby hopefully evading the administrative hassle of claims being processed with the 21.3% reduction, only to have to be reprocessed according to the retroactive freeze.

Regardless, it is possible that some provider payments will be processed and paid at the reduced rate. In that case, for any claims for which the charge was at or above the Pre-April 1 Medicare payment rate, the contractor will automatically reprocess the claim and pay the differential owed to the provider. In the event the charge was for a lower amount (i.e. the provider reduced the charge to the post-April 1 rate) the Medicare contractor will process the claim at the reduced rate (because it would now be below the allowable). Providers in this situation will have to refile the claim in order to get paid the differential they would be owed.

We’ll keep you posted as we get more information.


The Continuing Extension Act Vote Better Be Soon… The CMS Grace Period To Hold Claims Has Ended!

In Uncategorized on April 15, 2010 at 7:04 pm

Last night the Senate voted 60 to 40 to exempt the much-spoken-of-Baucus amendment (which says all spending legislation must be paid for) from the Continuing Extension Act (H.R.4851).  This significant vote moves the Senate closer to voting for bill itself.

In addition to dealing with the SGR, the underlying bill that senators are debating would temporarily extend funding for several federal programs that have expired, including unemployment benefits, COBRA health insurance subsidies for the unemployed, and the national flood insurance program.

Senate Democrats have been trying to pass the measure since before they left for a two-week recess, but failed to do so because of Republican opposition.

Republicans have blocked the bill because they don’t approve of passing a bill that isn’t paid for, while Democrats say the spending is for an “emergency” and is therefore not subject to Senate rules that require all spending be offset.

The underlying bill would extend most of the federal programs through April. However, with April being half over,  Sen. Baucus proposed another amendment which would extend the programs through May, the thought being to give Congressional leaders more time to work out an agreement on a bill passed by the House earlier this year, which would extend all of these programs for the remainder of 2010.

It is expected that Senators will vote on this second Baucus amendment and the underlying bill Thursday or Friday. If senators vote to extend the federal programs through May, the House would have to vote on the measure as well, which it is expected to do this week.

Most of the programs addressed in the bill — including the delay in doctor payment cuts — already expired April 1.

But doctors haven’t yet felt the blow from the April 1 pay cuts because, for the second time this year, the Centers for Medicare and Medicaid Services (CMS) stepped in and instructed contractors to hold claims for services performed on or after April 1 for the first 10 business days of the month. That grace period ended last night.

Still Awaiting A “Doc Fix” Update…. Detained In The Senate

In Uncategorized on April 14, 2010 at 3:37 pm

On Tuesday, April 13th, the Senate began consideration of the Continuing Extension Act (H.R. 4851), the House bill that has come to be known as the “doc fix,” which would provide a temporary extension of certain programs – most notably for the purposes of M.E.D.I.C., Inc.’s clients and others in the medical industry being the cancellation fo the 21.3% reduction in the Medicare Physician Fee Schedule. 

A unanimous-consent agreement was reached, however, providing for further consideration of the bill at approximately 10:30 a.m., on Wednesday, April 14, 2010.  Stay tuned…

CMS Comment Regarding Physical Therapy Cap Exceptions Process

In Uncategorized on April 8, 2010 at 7:25 pm

On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act, which extends the exceptions process for outpatient therapy caps (see Section 3103).  Outpatient therapy service providers may continue to submit claims with the KX modifier, when an exception is appropriate, for services furnished on or after January 1, 2010, through December 31, 2010.  

The therapy caps are determined on a calendar year basis, so all patients began a new cap year on January 1, 2010.  For physical therapy and speech language pathology services combined, the limit on incurred expenses is $1,860.  For occupational therapy services, the limit is $1,860.  Deductible and coinsurance amounts applied to therapy services count toward the amount accrued before a cap is reached.

Senate To Vote On MPFS Freeze April 12th

In Uncategorized on April 8, 2010 at 4:00 pm

The Senate returns from the Easter Recess on April 12 and has scheduled a cloture vote on the 30-day extension bill (H.R. 4851, the Continuing Extension Act of 2010) for 5:30 p.m. that evening.  While not quite an 11th hour vote, this is only 2 days prior to the expiration of CMS’ holding of claims which otherwise would have been affected by the 21.3% fee schedule cut on April 1st. 

This bill would, among other things, extend 2009 Medicare physician fee schedule rates through April 30, 2010, retroactively blocking a 21.3% physician payment reduction that went into effect April 1, 2010 under the sustainable growth rate (SGR) formula when a previous short-term fix contained in H.R. 4691 expired. 

Congress continues to struggle with crafting a longer-term solution to the Medicare physician fee schedule fix given the significant budgetary impact associated with this policy.

Zero-Percent Update To Medicare Physician Fee Schedule NOT Addressed by Senate… Claims To Be Held…

In Uncategorized on April 8, 2010 at 3:54 pm

HR-4851, the bill which addresses the additional 30-day extension of  the freeze on the Medicare Physician Fee Schedule, was passed by the House of Representatives in mid-March.  However, the Senate failed to act on the bill prior to adjourning for its two-week “Spring District Work Recess.” 

The fee schedule cut is techically supposed to have taken effect and applied to all claims with a date of service of April 1, 2010, or later.  However, CMS believes Congress is working to avert the negative update (i.e., 21.3% cut to the physician fee schedule). Consequently, CMS has instructed its contractors to hold claims containing services paid under the MPFS (including anesthesia services) for the first 10 business days of April. This hold will only affect claims with dates of service April 1, 2010, and forward. In addition, the hold should have minimum impact on provider cash flow because, under the current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt.