Senate Finally Delays Medicare Cuts, Again

Late Tuesday night, the U.S. Senate voted to freeze physicians' Medicare payment rates once again, forestalling a 21.2-percent cut that otherwise would have affected all claims for services provided in March. The freeze extends the current temporary 2010 fees until April 1.

The Centers for Medicare & Medicaid Services (CMS) said it removed the 10-day hold on Medicare claims it instituted on March 1.

"This 28-day freeze is worthless if Congress doesn't spend the next 28 days devising and passing a permanent new Medicare payment formula," said Texas Medical Association President William H. Fleming III, MD. "We need a rational Medicare physician payment system that automatically keeps up with the cost of running a practice and is backed by a fair, stable funding formula."

Dr. Fleming urged TMA and alliance members to use the TMA Grassroots Action Center to send that message to Sens. John Cornyn and Kay Bailey Hutchison and the Texas delegation in the House of Representatives.

"We need Washington to understand that they're playing politics with our patients' lives," Dr. Fleming said.

Watch videos of TMA members explaining how the Medicare Meltdown is affecting their patients and their practices.

The Senate voted 78 to 19 to approve the freeze. Senator Cornyn voted against the measure. Senator Hutchison did not vote.

CMS said that effective immediately, claims with dates of service March 1 and later that Medicare contractors are holding will be released for processing and payment. "Please keep in mind that the statutory payment floors still apply and, therefore, clean electronic claims cannot be paid before 14 calendar days after the date they are received by Medicare contractors (29 calendar days for clean paper claims.) In addition, the new law extends through March 31, 2010, the exception process for therapy claims reaching the annual cap, retroactive to January 1, 2010.  Affected providers may submit claims for exceptions to the annual therapy caps, with dates of service January 1 through March 31, 2010, using the KX modifier, following the pre-January 1, 2010, requirements for therapy cap exception."

March 17 is the deadline to decide whether to change your Medicare participation status. Signing a participation agreement means you agree to accept assignment for all covered services that you provide to Medicare patients in 2010. You have three options.

If you choose to participate in 2010:

  • Do nothing if you currently participate.
  • If you are not currently a Medicare participant, complete the agreement and mail it to TrailBlazer Health Enterprises. The change would be effective Jan. 1, 2010.

Limiting the number of Medicare patients means a physician can treat more non-Medicare patients and make more revenue since treating non-Medicare patients pays more than treating Medicare patients.

If you decide not to participate:

  • Do nothing if you do not currently participate.
  • If you are currently a participant, write to each Medicare contractor to which you submit claims, advising of your termination effective Jan. 1.

If you decide to opt out of the Medicare program:

  • PAR physicians' opt-out affidavit must be submitted 30 days before the next calendar quarter (i.e., Jan. 1, April 1, July 1, and Oct. 1) showing an effective date of the first date in that calendar quarter.
  • Non-PAR physicians may opt out at any time.
  • Before opting out, refer to TrailBlazer's Medicare Opt-Out Guidelines for Physicians/Practitioners [ PDF ].

The Participation Agreement (CMS-Form 460) is available on the CD-ROM distributed by TrailBlazer Health Enterprises and is posted on the TrailBlazer Web site.

Return the form to:

Medicare Part B
Participation Agreement
PO Box 650544
Dallas, TX 75265-0544 

TMA can't advise you which direction to take, but it has recorded a one-hour Web seminar with detailed information about your participation options and the consequences of those choices.

Action Special Issue , March 3, 2010


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