CMS Gives Update on Claim Status After Legislation Extending Medicare Payment Rates Passes

Claims from April 1-15 Will Be Paid at 2009 Rate

April 16, 2010 04:15 pm James Arvantes

Passage of a federal measure that extends the current Medicare physician payment rate through May 31 means physicians will not see a steep reduction in their Medicare payment rates for at least a little while, and CMS is instructing its contractors to begin processing claims according to the new law.

Congress passed and President Obama signed the bill on April 15. It postpones a 21.2 percent Medicare payment cut that took effect on April 1 until June 1.

CMS held payment of claims from April 1-15, awaiting passage of the payment legislation, and according to a press release from the agency, its contractors will now process held claims according to the new law for services provided by physicians and others who are paid according to the Medicare physician fee schedule, or MPFS,

CMS noted, however, that the statutory payment floors still apply; therefore, clean electronic claims cannot be paid before 14 calendar days after the date they are received by Medicare contractors. For paper claims, it is 29 calendar days, according to the CMS guidance.

"I have not heard that any Medicare carrier has processed claims from April 1 using the 21 percent cut," said John Swanson, director of the AAFP's Practice Support Division. "I have not heard of that occurring anywhere. Technically, nothing has changed. The zero percent update continues."

Lawmakers soon will take up legislation to extend the current payment rate until Oct. 1. Both the House and Senate have passed separate bills to accomplish this extension, and negotiations over how to pay for it are ongoing.

"The administration has repeatedly stated that the formula that determines what physicians and others are paid under the MPFS is broken and needs to be fixed," said Jonathan Blum, deputy administrator and director of the Center for Medicare Management, in the CMS press release. "(CMS) will continue to work with Congress to find a long-term solution (to the problem)."