What Physicians Need to Know About Medicare Payment Cuts – from the Tennessee Medical Association (TMA)

Apr 06, 2015 at 10:54 am by admin


The U.S. Senate’s recent inaction regarding the Medicare and CHIP Reauthorization Act means the current Medicare payment patch expired last Wednesday, April 1.  Subsequently, physicians are scheduled to receive a 21 percent cut in Medicare reimbursements.  However, the U.S. House of Representatives overwhelmingly approved H.R. 2 and it appears that the flawed Sustainable Growth Rate formula might finally be eliminated.  Senate leaders said they will vote on the bill promptly after Congress returns from it recess on April 13. In the meantime, this is what physicians’ practices need to know about the payment cuts: 1.    The Centers for Medicare & Medicaid Services is instructing its carriers to “hold” claims for ten (10) business days until legislation can be passed and signed into law that reverses the cut.2.    The ten (10) day hold means that claims will be held through April 14.  This is not a departure from standard practice.3.    By regulation, CMS may not pay electronic claims prior to fourteen (14) days (29 days for paper claims).4.    It is possible that the situation will be resolved before any claims are actually processed at the reduced rate.5.    The TMA anticipates that when Congress passes a bill, the restored payment rates will be applied retroactively.By law, Medicare is required to pay physicians the lesser of the submitted charge or the Medicare approved amount.  For that reason, TMA advises against submitting claims with reduced amounts reflecting the 21 percent cut. For additional information, please go to the TMA website:  http://tnmed.org/TM/Issues/SGR.aspx

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