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CMS Outlines Claims Processing Procedures for 2.2% Increase

On June 25, President Obama signed into law the "Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010."  The law reverses the 21.3% cut implemented on June 1 and establishes a 2.2% update to the Medicare Physician Fee Schedule (MPFS) payment rate through November 30, 2010.

 

The Centers for Medicare and Medicaid Services (CMS) has directed its contractors to discontinue processing claims at the negative rate and to temporarily hold all claims for services rendered June 1, 2010, and later, until the new 2.2% update rates are tested and loaded into the Medicare contractors' claims processing systems. Effective testing of the new 2.2% update will ensure that claims are correctly paid at the new rates. CMS expects to begin processing claims at the new rates no later than July 1, 2010. Claims for services rendered prior to June 1, 2010, will continue to be processed and paid as usual.

 

All claims that contain June 2010 dates of service which have been paid reflecting the 21.3% cut will be reprocessed as soon as possible. Under current law, Medicare payments to physicians and other providers paid under the MPFS are based upon the lesser of the submitted charge on the claim or the MPFS amount. Claims containing June dates of service that were submitted with charges greater than or equal to the new 2.2% update rates will be automatically reprocessed. Physicians who submitted claims containing June dates of service with charges less than the 2.2% update amount will need to contact their local Medicare contractor to request an adjustment. Submitted charges on claims cannot be altered without a request from the physician. Physicians should not resubmit claims already submitted to their Medicare contractor.

 

The Office of the Inspector General (OIG) posted a policy statement that clarifies that those physicians affected by retroactive increases in payment rates resulting from the operation of new Federal statutes or regulations that they will not be subject to OIG administrative sanctions if they waive retroactive beneficiary cost-sharing amounts attributable to those increased payment rates, subject to the conditions noted in the policy statement.  You can view the complete policy statement at www.oig.hhs.gov.

 

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