National Advocacy

The Centers for Medicare and Medicaid Services (CMS) has directed its contractors to discontinue processing claims at the negative rate and to temporarily hold all claims for services rendered June 1, 2010, and later, until the new 2.2 percent update rates are tested and loaded into the Medicare contractors’ claims processing systems. Effective testing of the new 2.2 percent update will ensure that claims are correctly paid at the new rates. CMS expects to begin processing claims at the new rates no later than July 1, 2010. Claims for services rendered prior to June 1, 2010, will continue to be processed and paid as usual.

All claims that contain June 2010 dates of service which have been paid reflecting the 21.3% cut will be reprocessed as soon as possible. Under current law, Medicare payments to physicians and other providers paid under the MPFS are based upon the lesser of the submitted charge on the claim or the MPFS amount. Claims containing June dates of service that were submitted with charges greater than or equal to the new 2.2 percent update rates will be automatically reprocessed. Physicians who submitted claims containing June dates of service with charges less than the 2.2 percent update amount will need to contact their local Medicare contractor to request an adjustment. Submitted charges on claims cannot be altered without a request from the physician. Physicians should not resubmit claims already submitted to their Medicare contractor.

The Office of the Inspector General (OIG) posted a policy statement that clarifies that those physicians affected by retroactive increases in payment rates resulting from the operation of new Federal statutes or regulations that they will not be subject to OIG administrative sanctions if they waive retroactive beneficiary cost-sharing amounts attributable to those increased payment rates, subject to the conditions noted in the policy statement.  View the complete policy statement.

Finally, on June 28 the Centers for Medicare and Medicaid Services (CMS) issued the following statement on Medicare enrollment:

“In consideration of the recent enactment of the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, which established a 2.2 percent update to the Medicare Physician Fee Schedule (MPFS), the Centers for Medicare & Medicare Services is offering physicians and other practitioners, whose current participation status is non-participating, the opportunity to become participating (PAR).  This opportunity is being offered only to those physicians/practitioners whose current PAR status is non-participating.  This opportunity is available through July 16, 2010.

“Non-participating physicians/practitioners who would like to become a participating physician/practitioner should download and complete the Medicare Participating Physician or Supplier Agreement (Form CMS-460).

“Any new CMS-460 form received during this limited enrollment period will be retroactive for claims with dates of service of January 1, 2010, and later.  However, the change in participation status will only apply to new MPFS claims submitted after your new status as a participating physician/practitioner is processed.  Claims previously submitted and processed will not be adjusted for only a change in participation status.

“Medicare claims administration contractors (Medicare Administrative Contractors and carriers) will accept and process requests to become a participating physician/practitioner that are submitted on the CMS-460 form and are post-marked on or before July 16, 2010.”