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CMS acts to limit impact of payment cut while awaiting Senate action

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The Centers for Medicare and Medicaid Services has informed providers of methods that will be used to handle payment claims until the U.S. Senate votes on a bill to repeal the Sustainable Growth Rate, a key factor in annual Medicare physician payment updates.

A 21% cut in Medicare physician payments took effect on April 1. The Senate failed to vote on the bill on April 13, after returning from a 2-week spring recess. The House passed a similar measure on March 26 in a vote of 392 to 37.

The Medicare Learning Network issued the following information for providers via its electronic bulletin, MLN Connects:

“The Centers for Medicare & Medicaid Services took steps to limit the impact on Medicare providers and beneficiaries by holding claims paid under the Medicare Physician Fee Schedule [MPFS] with dates of service on and after April 1, 2015. In the absence of additional legislation to avert the negative update, CMS must update payment systems to comply with the law, and implement the negative update.

“Beginning on April 15th, 2015, CMS will release held MPFS claims, paying at the reduced rate, based on the negative update, on a first-in, first-out basis, while continuing to hold new claims as they are received. CMS will release one day's worth of held claims, processing and paying at the rate that reflects the negative update. At the same time, CMS will hold the receipts for that day, thus, continuing to hold 10 days' worth of claims in total. This is to provide continuing cash flow to providers, albeit at the rate that reflects the negative update. This ‘rolling hold’ will help minimize the number of claims requiring reprocessing should Congress pass legislation changing the negative update.”

According to the CMS bulletin, claims for services furnished on or before March 31 are not affected by the payment cut and will be processed accordingly.

“We are working to limit any impact to Medicare providers and beneficiaries as much as possible,” the bulletin said. “The MACs will automatically reprocess the claims paid at the reduced rate if Congressional action is taken to avert the negative update. No action is necessary from providers who have already submitted claims for the impacted dates of service.” – by Matt Hasson