Physician Payment Cut Delayed

(RESTON/ACR) -- Based on the 2010 Medicare fee schedule final rule, the 21.2 percent cut to the conversion factor was scheduled to be implemented Jan. 1, 2010. However, as of December 19, 2009, Congress has passed legislation to apply a zero percent update to the conversion factor through Feb. 28, 2010. This means that instead of the 21.2 cut, the conversion factor for January and February 2010 will be the same as 2009. Below is information from CMS on how claims will be handled for the first 10 business days in January to ensure correct payments to physicians.


Information Regarding the Holding of Claims for Services Paid Under the 2010 Medicare Physician Fee Schedule


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 providers of services paid under the Medicare physician fee schedule, beginning Jan. 1, 2010. In this regard, CMS has instructed its contractors to hold claims for services paid under the Medicare Physician Fee Schedule (MPFS) for up to the first 10 business days of January (January 1 through January 15) for 2010 dates of service. This should have minimum impact on provider cash flow because, by law, clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt. Meanwhile, all claims for services delivered on or before Dec. 31, 2009, will be processed and paid under normal procedures.


The holding of claims allows Medicare contractors time to receive the new, updated payment files and perform necessary testing before paying claims at the new rates. CMS has instructed contractors to begin processing claims at the new rates no later than Jan. 19, 2010. Please note that most contractors are closed on the January 18 Martin Luther King Day holiday. Therefore, even absent a new update, most claims likely would not have been paid any sooner than Jan. 19, 2010, given the aforementioned statutory 14-day payment floor.


CMS has extended the 2010 Annual Participation Enrollment Program end date from Jan. 31, 2010, to March 17, 2010 ─ therefore, the enrollment period now runs from Nov. 13, 2009, through March 17, 2010.


The effective date for any Participation status change during the extension, however, remains Jan. 1, 2010, and will be in force for the entire year.


Contractors will accept and process any Participation elections or withdrawals, made during the extended enrollment period that are received or post-marked on or before March 17, 2010.