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
The Centers for Medicare & Medicaid Services (CMS) said
it removed the 10-day hold on Medicare claims it instituted on
"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.
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
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
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
- Non-PAR physicians may opt out at any time.
- Before opting out, refer to TrailBlazer's
Medicare Opt-Out Guidelines for
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
PO Box 650544
Dallas, TX 75265-0544
TMA can't advise you which direction to take, but it has
one-hour Web seminar
with detailed information about your participation options and the
consequences of those choices.
Action Special Issue
, March 3, 2010