CMS to Hold Medicare Claims

UpdateNews from CMS: Questions and Answers on Announced 10 Day Hold

Centers for Medicare & Medicaid Services (CMS) officials have instructed Medicare contractors not to process any physician Medicare claims for the first 10 business days of July because Congress failed to block the cut in payments to physicians.

The 2008 Medicare Fee Schedule by Geographic Region

We are still hoping that Congress will act quickly and fix the Medicare fee schedule retroactively, but for those of you who need to know, below are the  fee schedules  that implement the 10.6 percent cut effective July 1, 2008.

"By holding claims for health care services that are delivered on or after July 1, CMS will not be making any payments on the 10.6-percent reduction until July 15, at the earliest," Elizabeth Hall, director of the CMS Office of Legislation, said in an e-mail to several Senate and House of Representatives committees. "Meanwhile, all claims for services delivered on or before June 30 will be processed and paid in regular order."

Ms. Hall says CMS wants to work with Congress, physicians, and Medicare patients "to avoid any disruption in the delivery and payment of physician and nonphysician practitioner services beginning on July 1."

Health and Human Services (HHS) Secretary Mike Leavitt said HHS "will take all steps available to the department under the law to minimize the impact on providers and beneficiaries." He did not say what those steps might be.

"We urge Congress to move quickly when it returns from the 4th of July recess to pass a bipartisan bill that the president can sign. ... The bill should also extend the Transitional Medical Assistance program to help families transition from welfare to work and the Qualified Individual program, which provides important services to low-income beneficiaries," he said.

Secretary Leavitt said the Bush administration "is committed to working with Congress to secure passage of legislation that can be signed into law by the president. Once enacted, we will move promptly to reprocess claims and take other steps necessary to ensure that providers and beneficiaries are not negatively affected."

The American Medical Association issued a statement urging Congress to pass legislation to stop the cuts early in the week of July 7. However, it said, there is no guarantee that Congress will solve the problem immediately.

"Although the constant stream of e-mails from Medicare carriers to their physician listservs can be impossible to keep up with, it's a good idea over the next few weeks to pay especially close attention to any messages physicians receive from their own Medicare carriers so they can keep track of news from their carriers affecting claims processing and payment rates," AMA said.

But the most important thing you can do is to call your senators and ask your patients to call their senators and get them to pass HR 6331.

In addition, AMA has developed a document outlining physicians' Medicare participation options  [ PDF ]. AMA is not advising or recommending any one of the three options described in the document.

Action , July 1, 2008

Last Updated On

June 14, 2010

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