CMS Statement Regarding Claims Processing

Both the Senate and the House passed the bills late yesterday that will maintain a freeze on Medicare payments thru 5/31/10. As soon as the president signs the bill, which is a given, the freeze will be in effect.

Hopefully, none of your Medicare claims for dates of service 4/1/10 and after will be processed at the 21.2% lower rate as Medicare contractors were in the process of transitioning to the new lower fee schedule; but as CMS stated below, any claims paid at the lower rate would be re-processed to pay correctly once the legislation was fully passed and became law

CMS Statement Regarding Claims Processing

CMS continues to work with Congress towards possible legislative action to extend the zero percent update for the Medicare Physician Fee Schedule. The zero percent update expired on March 31, 2010.

We are hopeful that Congress will take action in the next few days.

Until now, CMS has been holding April 2010 date-of-service claims, anticipating congressional action. But that has not occurred.

Therefore, under current law, Medicare contractors will begin processing claims with dates of service April 1 and later at the negative update rates. This will begin as soon as systems are fully tested to ensure proper claims payment. And, Medicare contractors will pay these claims on a first in - first out basis.

If subsequent congressional action extends the zero percent update retroactive to April 1, 2010, Medicare will reprocess those claims at the higher rates. Claims with submitted charges at or above the higher rates will be able to be automatically reprocessed without further action.

Providers have the option of holding their affected claims until the legislative landscape becomes clearer.

Claims with dates of service prior to April 1, 2010, are not affected and will continue to be processed under normal procedures at the rates in effect on the date of service.