• Congress Overrides Veto, Turns Big Physician Pay Cut into a Small Increase
  • July 30, 2008 | Author: Edgar C. Morrison
  • Law Firm: Jackson Walker L.L.P. - San Antonio Office
  • The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) was enacted on July 15, 2008. As a result, the proposed payment cut of 10.6 percent in the original mid-year 2008 Medicare Physician Fee Schedule (MPFS) has been replaced with a 0.5 percent increase, retroactive to July 1, 2008.

    According to CMS, physicians, non-physician practitioners, and other providers of services paid under the MPFS should begin to receive payment at the 0.5 percent update rates in approximately ten business days or less. Trailblazer and other Medicare contractors are currently working to update their payment system with the new rates.

    To avoid a cash flow disruption for practitioners paid under the MPFS, Medicare Carriers will continue to process already filed claims that have been on hold on a rolling basis (first in/first out) for payment at the originally proposed -10.6 percent update level. CMS notes that "after your local contractor begins to pay claims at the new 0.5 percent rate, to the extent possible, the contractor will begin to automatically reprocess any claims paid at the lower rates."

    Under the Medicare statute, Medicare pays the lower of submitted charges or the Medicare fee schedule amount. Claims with dates of service July 1 and later billed with a submitted charge at least at the level of the January 1, 2008, to June 30, 2008, fee schedule amount will be automatically reprocessed. Any lesser amount will require providers to contact their local contractor for direction on obtaining adjustments. Non-participating physicians who submitted unassigned claims at the reduced non-participation amount also will need to request an adjustment. Finally, each practitioner should monitor its claims and be prepared to contact its carrier to reprocess any claims not automatically paid under the new fee schedule.