CMS Extends Medicare Claims Processing Hold through June 17. Physicians may experience slight delay in claims payment.

CMS announced this morning that they will continue to hold claims pending congressional action this week to address the sustainable growth rate (SGR) issue that otherwise would create a 21% cut in Medicare claims payment for services starting on June 1st. This announcement does mean a potential delays in claims payment for physicians but based on guidance the worse case scenario would be a 3 day delay, if any.

The announcement from CMS to Congress on this issue included the following background and context: The Continuing Extension Act of 2010, enacted on April 15, 2010, extended the zero percent (0%) update to the 2010 Medicare Physician Fee Schedule (MPFS) through May 31, 2010. At this time, Congress is still debating the elimination of the negative update that took effect June 1, 2010. CMS is hopeful that Congressional action will be taken within the next several days to avert the negative update. To avoid disruption in the delivery of health care services to beneficiaries and payment of claims for physicians, non-physician practitioners, and other providers paid under the MPFS, CMS had instructed its contractors on May 27th to hold claims for services paid under the MPFS for the first 10 business days of June (i.e., through June 14, 2010). This hold only affects MPFS claims with dates of service of June 1, 2010, and later. Given the possibility of Congressional action in the very near future, CMS is now directing its contractors to continue holding June 1 and later claims through Thursday, June 17, lifting the hold on Friday, June 18. This action will facilitate accurate claims processing at the outset and minimize the need for claims reprocessing if Congressional action changes the negative update. It also should minimize the provider and beneficiary burdens and costs associated with reprocessing claims. CMS indicated that they understand that the delayed processing of Medicare claims may present cash flow problems for some Medicare providers. However, it is expected that the delay, if any, beyond the normal processing period will be only a few days.

Health care providers and advocacy groups are urging Congress to take action on this issue quickly and hopeful provide for a longer term fix to this issue.