A bill that earlier this month passed both Houses of Congress with bipartisan support was vetoed on Tuesday, July 15, 2008 by President Bush. Congress quickly acted to override the veto, an action that requires a two-thirds majority vote in both the House of Representatives and the Senate.
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HR 6331, the Medicare Improvement for Patients and Providers Act of 2008, averts the 10.6 percent cut to the Medicare Physician Fee Schedule (MPFS) that was scheduled to take effect on July 1, 2008. The legislation provides an 18-month physician payment fix by continuing the MPFS at its current levels through the end of 2008 and granting an additional 1.1 percent positive update for 2009. This legislation is very similar to a bill previously introduced by Senator Baucus (D-MT).
In the interim, the Department of Health and Human Services (HHS) had intervened. The Agency announced that they would essentially freeze the Fee Schedule at its current levels for a period of ten days, affording time for Congress to address the matter upon return from recess for the July 4th Holiday.
Centers for Medicare & Medicaid Services (CMS) had instructed Medicare carriers to not process any physician and non-physician practitioner claims for the first 10 business days of July. Under current law, electronic claims are not to be paid any sooner than 14 days (29 days for paper claims) and not later than the 30th day they are submitted (otherwise, CMS must pay interest on those claims).
From CMS:
Physicians, non-physician practitioners and other providers of services paid under the MPFS should begin to receive payment at the updated rates in approximately 10 business days, or less. Medicare contractors are currently working to update their payment system with the new rates.
In the meantime, to avoid a disruption to the payment of claims for physicians, non-physician practitioners and other providers of services paid under the MPFS, Medicare contractors will continue to process the claims that have been on hold on a rolling basis (first in/first out) for payment at the -10.6% update level. After your local contractor begins to pay claims at the new rate, to the extent possible, the contractor will begin to automatically reprocess any claims paid at the lower rates.
Under the Medicare statute, Medicare pays the lower of submitted charges or the Medicare fee schedule amount. Claims with dates of service July 1 and later billed with a submitted charge at least at the level of the January 1 – June 30, 2008, fee schedule amount will be automatically reprocessed. Any lesser amount will require providers to contact their local contractor for direction on obtaining adjustments. Non-participating physicians who submitted unassigned claims at the reduced nonparticipation amount also will need to request an adjustment.
Contractor websites are being updated with the new rates and these should be available shortly.
Be aware that any published MLN Matters articles affected by the new law will be revised or rescinded as appropriate.
Be sure to check the Medicare portion of the ACA Web site and in future issues of Week in Review for the most up-to-date information.
More information on claims processing
Frequently Asked Questions Regarding the Updated Fee Schedule
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