Claims Paid Under the Medicare Physician Fee Schedule

To the extent possible, the Centers for Medicare & Medicaid Services (CMS) is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other Fee-For-Service (FFS) providers of services paid under the Medicare physician fee schedule, beginning July 1.  In this regard, CMS has instructed its contractors to hold these claims for the first 10 business days of July, for dates of service in July.  This should have minimum impact on provider cash flow because, under current law, electronic claims are not paid any sooner than 14 days (29 days for paper claims) after the date of receipt.  Meanwhile, all claims for services delivered on or before June 30 will be processed and paid under normal procedures. 

After 10 business days, contractors will begin releasing claims into processing under the fee schedule which implements current law.  This, of course, could result in claims being processed with the negative 10.6 percent update.  If a new law is enacted which changes the negative 10.6 percent update, retroactive to July 1, CMS is prepared to automatically reprocess most of those claims which have already been processed. 

Under the Medicare statute, Medicare pays the lower of submitted charges and 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 will be automatically reprocessed if Congress retroactively reinstates the update that was in effect for that time period.  Any lesser amount will likely require providers to re-submit a revised claim. 

To the extent possible, providers may hold claims in-house until it becomes clearer as to whether new legislation will be enacted or until cash flow becomes problematic.  This will reduce the need for providers to reconcile two payments (i.e., the initial claim and the reprocessed claim), and it will simplify provider billings of beneficiary coinsurance and payment calculations for payers which are secondary to Medicare. 

Doctors Win a Reprieve from Medicare Pay Cut

From the Wall Street Journal Health Blog:

The brinkmanship over Medicare’s payments to doctors has gone to a new level.

For those of you new to the issue, a quick summary: A few years back, Congress created a Medicare funding formula that suggests payments to physicians should be cut. But each year, just before the pay cut goes into effect, Congress steps in and blocks it with a temporary measure.

The current temporary measure is set to expire tomorrow, when a 10.6% cut is scheduled to take effect. Last week, the Senate narrowly failed to pass a bill that would have blocked the pay cut.

Medical helicopters collide at hospital


At least seven people died and three were critically injured after a midair crash between two medical helicopters at an Arizona hospital on Sunday, authorities said.

At least one person killed in the crash, which occurred at 3:45 p.m., was a patient, according to FAA communications manager Ian Gregor.

The patient and two others were aboard a Bell Jet Ranger helicopter operated by Air Methods Corporation, an air medical service provider, Gregor said.