CMS will hold physician services claims for 10 business Days

Breaking news from CMS.

CMS has instructed its contractors to hold claims containing services paid under the MPFS (including anesthesia services) for the first 10 business days of April.

• This hold will only affect claims with dates of service April 1, 2010, and forward.
• In addition, the hold should have minimum impact on provider cash flow because, under the current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt

Senate fails to pass 30-day "doc fix" to prevent 21.3% Medicare payment cut for physicians effective April 1st

The Senate has adjourned for its two-week spring recess without approving H.R. 4851, a short-term measure that would have extended the freeze on Medicare’s current physician payment rates through April 30.

Several Senate Republicans led by Tom Coburn of Oklahoma objected to classifying the bill, which also included extensions of unemployment benefits and COBRA insurance, as emergency spending. The House of Representatives passed the bill on March 17. By law, the 21.3 percent cut to Medicare physician payments will take effect April 1.

However, in similar situations in the past, the Centers for Medicare & Medicaid Services (CMS) has instructed carriers to temporarily hold claims. While CMS has not made this announcement yet, we exect that CMS will hold claims for the first 2 weeks of April.

The Senate returns April 12 and has scheduled a cloture vote on the 30-day extension bill for 5:30 p.m. that evening. Physician offices should contact their Senators and urge them to permanently address this issue by repealing the sustainable growth rate (SGR) formula. This is frustrating and disappointing but as long as Congress acts on April 12th there will hopefully not be an impact for physicians due to the normal lag in claims processing by CMS.

President signs Health Reform into Law; But Many Issues Remain

The President signed health care legislation into law today. Today's ceremonies followed a very busy weekend in Washington DC with the House approving late Sunday night the Senate Health Reform bill and Reconciliation Language.

The House took two separate votes on the reform legislation. First, the House passed - by a vote of 219 to 212 - HR 3590, the Patient Protection and Affordable Care Act, the bill approved by the Senate last December. The House then passed HR 4872, the Health Care and Education Affordability Reconciliation Act of 2010, by a vote of 220 to 211. This legislation modifies the Senate bill with a number of "fixes" negotiated over the last two months by the House and Senate. As expected, not a single House Republican voted in favor of either measure.

The contentious, year long health reform debate is not finished, however, as H.R. 4872 goes to the Senate, where only a simple majority is needed to approve the bill under the reconciliation process. The Senate will consider the modification bill under streamlined procedures that avoid time-consuming cloture motions to begin and end debate on the bill. Senate Republicans are expected to offer numerous amendments and raise multiple points of order to the legislation. If the bill is changed in any way prior to Senate approval, it must return to the House for an additional vote before the President can sign it. A timeline on the Senate debate of the reconciliation measure has not yet been officially released but is expected to proceed quickly given the upcoming Spring recess which is supposed to start at the end of the week.

Even with passage of the most historic health reform legislation since the enactment of Medicare, policy insiders anticipated a reinvigorated battle over the future of Medicare as the Senate considers the reconciliation language. Also expected on the horizon are appropriations funding battles for the provisions of the bill of discretionary spending provisions and threats of court cases in several states over requiring individuals to purchase health insurance.

The Senate this week will also consider a new short-term extension bill (HR 4851) to extend the delay in Medicare physician rate cuts until April 30. The current extension expires on March 30. The House approved the measure on Wednesday. The Senate approved a longer-term extension (HR 4213) earlier this month which is pending action in the House. This is one of several critical issues yet to be addressed. Next up...the real work begins on the implementation of health reform.

Health Reform -- Too Close to Call

Speculation is growing that Democrats do not yet have the votes necessary to pass a healthcare reform bill. At the same time, House Speaker Pelosi has signaled she will work to push through health reform well before the coming spring recess.

The House Democratic Caucus was reportedly told by their leadership this morning that there would be a single, closed health reform vote within the next week, to include the reconciliation provisions (amendments to the Senate health reform bill and a student aid package) and the Senate passed reform bill. The Senate bill vote is wrapped into the single vote, so when members vote for or against the reconciliation package they will also be voting for or against the Senate passed health reform bill. Once passed, the Senate bill would go to the President for signing, and the reconciliation provisions would go to the Senate where they must pass the provisions unchanged. The Senate Parliamentarian ruled earlier this week that the President must sign Congress' original health care reform bill before the Senate can act on a companion reconciliation package. Some speculate this new twist could create new challenges for health reform legislation.

The White House has been pressing for a vote next week, but lingering questions this week cast doubt on whether the House would vote on the reform provisions before Congress adjourns for two weeks on March 26th.

Senate Passes A 6-Month Fix to SGR Issues

Senate passes another temporary fix to SGR and Medicare Pay extenders This week the Senate passed another temporary Medicare physician payment patch by a vote of 62-36. The bill prevents a cut to Medicare physician reimbursement and instead holds payment levels flat until October 1, 2010. The legislation extends several programs related to unemployment and COBRA benefits, as well as other tax provisions and federal programs. It also includes language to delay DME accreditation requirements for pharmacies until January 2011 and exempts pharmacies where DME is less than 5% of sales.

The following lists some of the key health extenders contained in the American Workers, State, and Business Relief Act of 2010, as passed by the Senate:

• Provides a nine month extension of the 65% COBRA premium assistance (through December 31, 2010) and extends the enhanced Medicaid FMAP increase from the American Recovery and Reinvestment Act through 2010.
• Provides a six month extension of the 0% update to the 2010 Medicare physician fee schedule (through September 30, 2010).
• The 1.0 floor for the work geographic practice cost index (GPCI) used to help calculate the Medicare physician fee schedule update would remain in effect through 2010 which is important for rural physicians.
• Extends the Medicare exceptions process for outpatient therapy services through December 31, 2010.
• Extends for one year (to January 1, 2011) the date by which certain pharmacies must be accredited as durable medical equipment (DME) suppliers and allows HHS to establish alternative quality standards and accreditation requirements for pharmacies.
• Extends the Medicare mental health services 5% add-on payment through December 31, 2010.