Medicare claims may be delayed in April, as Congress mulls postponing cut

A 2% “sequester” cut in Medicare payments scheduled to take effect April 1 is now in doubt, which could lead to delays in the processing of Medicare claims this month. Last week the U.S. Senate passed a bill postponing the cut until next year, in response to advocacy from the American Academy of Family Physicians and others. The U.S. House of Representatives is expected to act on the bill when it returns from recess on April 12.

As a result, traditional Medicare claims with dates of service on or after April 1 may be delayed as Medicare contractors hold them rather than process them with the 2% cut, only to then have to reprocess them if the House reverses the cut.

There is already a statutory 14-day payment floor on clean claims, which gives Medicare and its contractors some wiggle room in situations like this. Assuming the House passes the legislation the week of April 12, that will eat up most of the 14 days for dates of service on or after April 1, but the payment floor may mitigate some of the potential disruption and minimize any delay in claims payments.

— Kent Moore, Senior Strategist for Physician Payment

Posted on Apr 01, 2021 by FPM Editors