CMS to Begin Processing Claims at 21.3 Percent Cut Rate on Friday June 18
Contact Your Senator — Urge Them to Act Now on Reversing This Cut
As you know, last month the House passed H.R. 4213, legislation that included tax extensions and a 19 month physician payment fix. Unfortunately, the Senate has not acted on this legislation and technically a 21.3 percent cut in Medicare physician payments went into effect on June 1. However, CMS has been holding claims for 10 business days to give Congress time to enact legislation to reverse this cut.
Today would have been the last day that CMS could legally hold claims before having to begin processing claims at the reduced rate tomorrow. However, CMS announced today that they will extend the hold for three additional days and will begin processing claims at the reduced rate on Friday, June 18 unless Congress acts.
The Senate needs to feel pressure from physicians that this cycle of temporary fixes every few months must end and H.R. 4213 needs to be passed. AGA members are encouraged to contact their senators using the Alliance of Specialty Medicine’s legislative hotline to urge them to prevent the cuts.Call the toll free number, 1-866-899-4088, to connect with your legislators; when prompted, press 4242 or bypass the introduction by pressing 1, then 4242.
If you would prefer to send a letter, you can use AGA's online advocacy system.
What Can Gastroenterologists Do About the Cuts?
Beginning Friday, physicians will have two choices for how to handle their Medicare claims.
Physicians can hold their claims until the pay rate is fixed and be reimbursed the correct amount the first time. However, this may cause difficulty for many smaller practices in meeting payroll and other overhead expenses with no revenue received from Medicare reimbursement.
The second option for physicians is to submit claims right away and get reimbursed one-fifth less, leaving Medicare to settle the difference retroactively once a bill has passed Congress.
Upcoming Congressional Action
The Senate plans to vote this week on H.R. 4213, but may not complete work on it until Wednesday or Thursday. AGA has been assured that once Congress passes H.R. 4213, any claims processed at the 21.3 percent reduction rate will be fixed retroactively. However, passing H.R. 4213 is still not a given and Senators need to hear from physicians that enough is enough —this cut must be fixed to provide physicians and beneficiaries some stability. Although H.R. 4213, which includes a 2.2 percent update for the rest of 2010 and a 1 percent update for 2011, is far from ideal, AGA recognizes the political realities and fiscal constraints under which Congress is operating.
The AGA will continue to urge the Senate to move forward on H.R. 4213 and will continue to provide timely updates on this critical issue via AGA eDigest and the AGA Washington Insider.
