Medicare Initiates Plans to Pay Claims With 21% Cut

Photo by frankleleon, via flickrUPDATE: 10:30 a.m., 4/16/15

The Senate repealed the SGR on the evening of April 14.  However, because the bill has not yet been signed, a small number of claims are being processed at the reduced rate, on a rolling basis.

When the bill is signed, Medicare’s contractors will automatically reprocess those claims at the higher rate.

With the Senate’s vote on the SGR repeal legislation still up in the air,

Medicare’s billing contractor announced that on April 15, it will start processing April claims at reduced rates, on a first-in, first-out basis.

Medicare payment rates were cut by 21% on April 1, following the expiration of the latest SGR payment “patch.” CMS routinely holds claims for 10 business days, so until now, practices’ cash flow was not affected. This “rolling hold” is designed to minimize the impact on practices to greatest extent possible.

There’s still a chance the repeal will pass by April 15. But if Congress acts after April 15, the new rate would be retroactive to April 1.

If there’s any positive news here, it’s that practices will NOT be required to resubmit claims initially paid at the lower rate. National Government Services said it will automatically reprocess those claims and issue checks for the difference.

Claims for services provided before April 1 are not affected by the payment cut.

For more information, visit the National Government Services website.

  1. K Murray Leisure MD says:

    This threat is last minute government bullying and extortion to pass legislation unfavorable to physicians and Medicare patients. The MMS, AMA, and other groups endorsing SGR HB2 should reverse their positions and reconsider. Physicians and Medicare patients would benefit realistically in the long run if the SGR HB2 non “Doc Fix” legislation this April 2015 does NOT pass unless all the dozens of quirky regulatory requirements and pork add ons are removed. Section 207 of SGR gives far too much power and three years of funding — 2015, 2016, and 2017 — perhaps a nice $90 million dollars or more — to the controversial National Quality Forum, NQF, lead by former ABIM CEO Christine Cassel, MD. NQF’s former activist Dr Chuck Denham, w minimal infection control credentials, co chaired a Quality Forum committee in 2009 on “safe practice” guidelines. They endorsed 2% chlorhexidine and alcohol (ChloraPrep) as antiseptic skin cleanser. The committee did not know that Denham had $11.6 million in contract with CareFusion, producers of ChloraPrep. In January, 2014, the US Dept of Justice settled on a $40 million fine against Denham and CareFusion, claiming the $11.6 million as a kickback to get him to manipulate NQF standards and boost sales of the antiseptic solution. Will legislators and physicians allow NQF unlimited power to market their MOC(trademark) recertification test programs as the ultimate authority for “review, endorsement and maintenance of quality and resource us measures, as well as…the pre-rule process and measure dissmeniation and review activities” in this bill HB2? On June 12, 2013, ABMS, the Board of Medical Specialties, and Dr Nora wrote to US House of Representatives Committee on Energy & Commerce (Hon Fred Upton, Hon Henry Waxman) a 6 page letter promoting and protecting with legal immunity their ABMS MOC (trademark) ” ‘ learning system’ of measure evaluation and improvement” (p 6) to be incorporated into any future Medicare reform proposal “surrounding repeal of the physician sustainable growth rate (SGR)” on page 1 (T Granatir, L M Nora, ABMS, to Chairman Upton, 6/12/2013, on ABMS web site). Surely MMS, the AMA, Senators Markey and Elizabeth Warren would not want to pass legislation like Section 207 in the SGR which might be construed as racketeering and influence peddling for MOC (trademark) products and physician quality measures which could be produced with greater validity, more science, and at significantly less costs for US healthcare by other firms. In light of the heavy regulatory burden associated with the April 2015 version of SGR, please end your support of SGR. Kindly note that linking ABMS MOC into MIP and other measures for Medicare payments violates MMS policy (12/6/2014) and AMA’s statements (bullet 4, November, 2014) AGAINST linkage of MOC to insurance payments.

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