Medicare Claims on Hold for 10 Days

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Anticipating that Congress will once again overrule the 21% physician pay cut scheduled to begin today, CMS has instructed its contractors to hold claims for 10 days while yet another temporary sustainable growth rate formula fix is legislated.

According to a notice from the American Hospital Association, CMS asked its contractors to hold claims paid under the Medicare Physician Fee Schedule for the first 10 business days of June.

The 10-day hold is not expected to negatively affect cash flow because the agency does not begin to pay electronic claims until 14 days after they are received.

Meanwhile, a tax extenders bill that also would provide a last-minute infusion of funds to head off the looming physician pay cut under Medicare was introduced last week that, if passed, would stabilize Medicare payments through 2013 at a cost of $63 billion over the next 10 years, according to an article in Politico.

According to an interview with a correspondent from Kaiser Health News, Congress was considering a multi-year fix that would expire in 2014 and that would provide modest increases in the ballpark of 1% for physicians, possibly more for physicians that do preventative care. If the parties fail to come to an agreement on that, then a short-term fix is possible.

However, in a parliamentary move on Friday afternoon, the House peeled a $23 billion physician fix off a pared down bill, passed both measures, and sent them to the Senate, which is expected to begin debate the week of June 7, according to an article in the Wall Street Journal.

As lawmakers started leaving town for the three-day Memorial Day weekend, the president of the American Medical Association expressed frustration with Congress.

“The Senate has turned its back on seniors, and America’s physicians are outraged that Congress has deserted patients by failing to address this year’s Medicare cut before the June 1 deadline,” J. James Rohack, MD, states. “Senators are more interested in heading home for the holiday than in preventing a Medicare meltdown for seniors….Already, about one in four Medicare patients looking for a new primary care physician have trouble finding one, and congressional inaction will make it much worse.

“Enough is enough: nine times in eight years Congress has delayed the cut and not fixed the problem. Congress needs to buckle down, stop growing the problem and fix it once and for all to save the Medicare and TRICARE programs for America’s seniors and military families.”