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SENATE TO VOTE ON MEDICARE PAYMENT

07/01/2008 MEDICARE PAYMENT - Senate vote to stop Medicare payment cuts fails
 
The Senate voted on the House-approved Medicare Improvement Act for Patients and Providers (H.R. 6331). This important legislation, supported by MGMA, would have halted the scheduled 10.6 percent cut in physician payment scheduled for July 1 and the projected 5 percent cut for 2009. The bill would have continued the 0.5 percent increase for 2008 now in effect and provided an additional 1.1 percent increase for 2009.

Unfortunately, the vote failed, with 58 “yes” votes to 40 “no” votes. Sixty Senate votes were required to move this bill to the Senate floor for further consideration. Senate majority leader Harry Reid, D-Nev., initially voted “yes” but changed his vote to “no” as a procedural maneuver to allow the bill to be reconsidered at his discretion.

It appears certain that physicians will now receive a 10.6 percent reduction in Medicare payments on July 1. When Congress reconvenes following the July 4th recess, lawmakers will most likely consider additional legislation to fix these cuts retroactively. 

See how your senator voted. 
www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=110&session=2&vote=00160

CMS instructs carriers to temporarily hold claims
Over the weekend, the Centers for Medicare & Medicaid Services (CMS) instructed carriers to temporarily hold claims. In its statement, CMS said: “To the extent possible, CMS wants to work with Congress, health care providers and the beneficiary community to avoid any disruption in the delivery and payment of physician and nonphysician practitioner services beginning on July 1. In this regard, the agency plans to instruct its contractors to not process any physician and nonphysician practitioner claims for the first 10 business days of July. Under current law, electronic claims are not to be paid any sooner than 14 days (29 days for paper claims) and not later than the 30th day they are submitted (otherwise, CMS must pay interest on those claims). By holding claims for health care services that are delivered on or after July 1, CMS will not be making any payments on the 10.6 percent reduction until July 15, at the earliest. Meanwhile, all claims for services delivered on or before June 30 will be processed and paid in regular order.” 

After 10 business days, contractors will begin releasing claims into processing under the fee schedule which implements current law.  This, of course, could result in claims being processed with the negative 10.6 percent update.  If a new law is enacted which changes the negative 10.6 percent update, retroactive to July 1, CMS is prepared to automatically reprocess most of those claims which have already been processed.

Under the Medicare statute, Medicare pays the lower of submitted charges and 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-June 30, 2008, fee schedule will be automatically reprocessed, if Congress retroactively reinstates the update that was in effect for that time period.  Any lesser amount will likely require providers to re-submit a revised claim.

To the extent possible, providers may hold claims in-house until it becomes clearer as to whether new legislation will be enacted or until cash flow becomes problematic.  This will reduce the need for providers to reconcile two payments (i.e., the initial claim and the reprocessed claim), and it will simplify provider billings of beneficiary coinsurance and payment calculations for payers which are secondary to Medicare.

CMS ‘clarifies’ 10 business-day holding period on Medicare claims
MGMA has been asked to communicate the information below based on our discussions with the Centers for Medicare & Medicaid Services (CMS). MGMA remains extremely concerned regarding the potential for confusion and high probability for claims delays throughout the month of July.

CMS has recommended that practices take the following steps during the 10 business-day hold on Medicare claims processing:

• Submit claims for services provided on or after July 1 at or above the Medicare fee schedule rate paid for services provided during the first half of 2008.  Practices that bill below the amount paid for services provided prior to July 1 will be required to resubmit claims if a new law is enacted that fully reverses the cut in order to receive the increased amount.

• Beginning July 1, collect patient co-payments based on revised fee schedule amounts reflecting the 10.6 percent cut, as provided by your Medicare carrier.

• Obtain signed Advanced Beneficiary Notices or Notices of Exclusion from Medicare Benefits in cases where caps may be exceeded for outpatient physical and/or occupational therapy and speech language pathology services.

07/02/08: Medicare Payment Information

The following information was released on 7/02/2008 from CMS: 
The Questions and Answers below apply to the recent decision by the Centers for Medicare & Medicare Services to hold claims paid under the Medicare physician fee schedule (MPFS) up to 10 business days that contain July 2008 dates of service. 

Q1.      Will claims containing services paid under the MPFS be held that contain both June and July dates of service?
A1.      Yes, your local contractor will hold the entire claim for 10 business days.

Q2.      Will claims be held that contain both services paid under the MPFS and services paid under a separate fee schedule?
A2.      Yes, claims that contain both services paid and not paid under the MPFS will be held. For example, a claim with a July date containing an Evaluation and Management code and a drug code would be held.

Q3.      Does the holding of claims paid under the MPFS also include anesthesia and purchased diagnostic services?
A3.      Yes, contractors will hold all claims with dates of service July 1, 2008, and after that contain services paid under the MPFS, including anesthesia and purchased diagnostic services.

Senate to vote again on H.R. 6331, continue calling your senators
The Senate leadership has indicated when Congress reconvenes following the July Fourth recess, the Senate will vote again on legislation to retroactively fix the 10.6 percent cut that takes effect July 1. It is therefore extremely important for MGMA members to call their senators. MGMA is coordinating our grassroots efforts with the American Medical Association and physician specialty societies and ask that you please use the unified grassroots hotline at 800.833.6354 to call Congress.

A number of senators have attempted to justify their prior* “no” votes on H.R. 6331 based on Medicare patient access and other concerns. The White House has also threatened a veto using the same rationale.  MGMA strongly supports the Medicare Advantage provisions in H.R. 6331.  Please use the following information to counter the political messaging of the administration and senators who oppose the bill.

Myth: H.R. 6331 would restrict access to Medicare Advantage Plans.
Fact: The “deeming” reforms included in H.R. 6331 apply only to fee-for-service Medicare Advantage plans in states where other plans have already established physician networks. Currently, physicians in such states are automatically deemed to be part of a network and are bound by a plan’s terms and conditions whenever they care for a private fee-for-service patient--even those physicians who have never seen or signed a contract informing them of the plan’s requirements. H.R. 6331 would not put these private fee-for-service plans out of business. Rather, the bill would give these plans two years to establish bona fide physician networks and, importantly, put them on an even playing field with other Medicare Advantage plans—including HMO, PPO, and network-based MSA plans--that have already gone through the network development and contracting processes. Those rural areas where physician networks are difficult to establish and beneficiaries are served by only one Medicare Advantage plan would not be affected by H.R. 6331.

Myth: H.R. 6331 would restrict competition.
Fact: By leveling the playing field between fee-for-service and other types of Medicare Advantage plans, and by making all plans adhere to the same contracting and network development requirements, H.R. 6331 actually enhances competition. The bill eliminates the unfair marketing advantage currently enjoyed by fee-for-service plans in states where other Medicare Advantage products exist.

Myth: The deeming provisions in H.R. 6331 would cut payments to Medicare Advantage plans.

Fact: The program savings achieved by the deeming provisions would not result from payment cuts. Rather, by applying a consistent set of networking and contracting rules across all plans, the current rapid rate of enrollment growth in private fee-for-service plans will be reduced in non-rural areas where other Medicare Advantage plan choices are available.

 

UnitedHealthcare Provider Outreach
07/0208: Updated list of CPT codes posted for the Radiology Notification Program
The revised coding table contains the CPT-4 codes that require notification for the UnitedHealthcare Radiology Notification Program. Notification numbers represent the specific radiological procedure you are requesting and are valid for 45 calendar days from the date they are issued. This list is available in the Members Section of our web site www.mgmamd.org.

New Claims Reconsideration Quick Reference Guide
An updated document to aid physicians and office staff in navigating claims reconsideration submissions is available in the Members Section of our web site www.mgmamd.org.

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