The Continuing Extension Act of 2010, enacted on April 15, 2010, prevented a 21.2% reduction in Medicare Part B payments by extending the 2009 rates through May 31, 2010. Legislation has not yet been approved to prevent the reduction, therefore, the 2010 Medicare Physician Fee Schedule rate and 21.2% reduction is now effective.
The Centers for Medicare and Medicaid Services (CMS) has instructed its contractors to hold claims for services paid under the 2010 Medicare Physician Fee Schedule for the first 10 business days of June. Any legislation that is passed by Congress would likely be retroactive to June 1, and CMS wants to avoid having to reprocess claims paid under the 21.2% reduction. This hold should have minimum impact on providers because electronic claims are not paid sooner than 14 calendar days and paper claims are not paid sooner than 29 calendar days.
If you are a participating provider in Medicare (i.e., a provider that receives payments directly from Medicare), you may want to delay billing a patient for co-payments until new legislation is approved. Otherwise, participating providers may bill a co-payment at the 21.2% reduced rate and then have to re-bill the patient for the difference in the co-payment when rates are adjusted. Similarly, non-participating providers (i.e., a provider that receives payment from patients) may want to delay billing patients both the co-payment and the charge for the service. If providers do choose to bill patients prior to the rate adjustments, they should inform the patient that there will be an upward bill adjustment when the adjustment becomes effective by congressional action.
ASHA's analysis of the 2010 Medicare Physician Fee Schedule is available on ASHA's Web site. For further information, please contact Kate Romanow, ASHA's director of health care regulatory advocacy, at 301-296-5671 or firstname.lastname@example.org; or Mark Kander, ASHA's director of health care regulatory analysis, at 301-296-5669 or email@example.com.