Novitas Solutions, the Medicare administrative contractor for Texas, has held physician Medicare payments for services rendered in January 2021 to comply with changes to federal laws, the Texas Medical Association has confirmed.
The hold was caused as Novitas updated its fee schedule files to comply with the Consolidated Appropriations Act, the omnibus spending and COVID-19 relief bill signed into law Dec. 27, a Novitas spokesperson told TMA.
Last week, Novitas began releasing some Medicare claims to be processed for payment, and the contractor anticipates releasing the remaining held claims by the end of this week, the spokesperson said.
Physicians should note that once the claims are released, there is an additional 14 days for the claims to process.
If you do not receive payments within the next few weeks, TMA recommends you contact Novitas directly.
This delay was first reported to TMA via the Reimbursement Review and Resolution Service (previously known as the Hassle Factor Log), free to physician members. Similar holds also have been reported in Maryland, Florida, and California.
TMA urges practices to check their claims records continuously for any missing payments or other discrepancies.
The Consolidated Appropriations Act included several changes that affect physicians’ bottom line, including:
- A 3.75% overall increase to the Centers for Medicare & Medicaid’s fee schedule payments for 2021;
- Extending suspension of the Medicare sequestration payment cut through March 31; and
- Retaining the work Geographic Price Cost Index (GPCI) floor of 1.0, which helps keep physician payments from decreasing further, through the end of 2023.
To account for the changes, CMS said it recalculated payment rates and the conversion factor used to determine certain payments. The 2021 conversion factor is now $34.8931, an increase from the originally set $32.41.
If you have any questions about Medicare billing and coding, contact TMA’s reimbursement specialists via email, or the TMA Knowledge Center at (800) 880-7955 or via email.
Last Updated On
February 02, 2021
Originally Published On
February 02, 2021