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  • Anticipating Patch Legislation, CMS Puts Hold On Claims Processing

    While a proposed "patch" to scheduled reductions in the 2014 Medicare Physician Fee Schedule (MPFS) may be imminent, the Centers for Medicare and Medicaid Services (CMS) is implementing a 10-business-day claims-processing hold just in case Congress doesn't take action to prevent the reductions before a March 31 deadline.

    In an e-mail alert sent to various groups, CMS states that it is "hopeful that there will be congressional action to prevent the negative update from taking effect on April 1, 2014. CMS has instructed the Medicare Administrative Contractors to hold claims containing services paid under the MPFS for the first 10 business days of April (ie, through April 14, 2014)."

    The hold would only affect MPFS claims with dates of service of April 1, 2014, and later. CMS believes that the hold will have minimal impact on provider cash flow, because under current law, clean electronic claims are not paid any sooner than 14 calendar days after the date of receipt. All claims for services delivered on or before March 31, 2014, will be processed and paid under normal procedures, regardless of any congressional actions.


    • I would like to hear one time where the congressman and congresswomen pay checks go on hold for 10 days and that it will not affect their cash flow. We take large cuts last year which certainly affected my practice income hence my income. They introduce convoluted g code rules that Medicare screwed up and were not processed correctly and messing with our reimbursement....hence cash flow. Just another frustrated private practice owner! Oh one last thing, let's tell our congressmen and congresswomen that their first hour of work everyday they get paid their agreed upon hourly rate and the rest of the day they are paid 20% less since they are already in the building and they have less expense to get to work! We have to do that why shouldn't they?

      Posted by James Trout on 3/28/2014 8:59 PM

    • Agree completly with Mr. Trout. In addition, the only work that the congressionperson gets paid for is what they do themself or with direct oversight of 2-3 licensed staff. All other work would go unpaid-even if they were in direct supervision of the staff.

      Posted by John Hendrickson on 3/30/2014 10:02 AM

    • We could take that one step farther...why don't we put ALL of congress on Medicare or Obama care? They have managed to exempt themselves from Obama care and they do not use Medicare. Wouldn't it make sense for all of congress to engage in the same plans with the same costs that the general public has to?

      Posted by Claire Kristl on 3/30/2014 10:44 AM

    • Hear, hear. I am so tired of our cost effective, preventive care being thrown under the bus compared to ALL OTHER PROVIDERS. I don't believe any of them have to track dollars spent annually for such meager claims like we do. Ambiguous diagnostics, redundant drug regimens and invasive, risky procedures are readily paid and still we are pushed aside, yet we save serious bacon for our clients and tax payers. That congress fails to perceive this is atrocious, and that our lobbyists can't convince them is a travesty. I am sick of educating my patients, payers, congressmen and administrators on the dire straits of our reimbursement, with only further cuts in sight. The dubious "functional impairment ratings" of the G Codes are the ultimate insult. Where did the bean counters derive such meaningless, arbitrary values? I'm not sure I could dream up measures that reflect so little of our growing evidence base if my career depended on it. I could cry a river over the lack of support we have for some of the most relevant, least invasive, and proactive interventions in western medicine. Every time I read evidence about "lifestyle illness" such as diabetes, surprise surprise, the best strategies point again to activity which we, the so-called experts in mobility, facilitate. How disturbing that our government and entire medical culture continue to devalue our profession. And, how misguided the origins of the SGR bill in efforts to reduce medical costs. I may have to add "scapegoat" to my official credentials this year. Perhaps by minimizing my own expectations I can somehow adopt a tolerable outlook on current regulations and the paltry results of our vocation's political efforts.

      Posted by kate humphrey, mpt on 3/30/2014 4:21 PM

    • Another suggestion would be that we put patients with Medicare insurance on HOLD for 14 days and provide them with legislator's phone numbers. Then they, the consumers, would QUICKLY phone Washington, DC and complain. But wait, therapist are ethical and wouldn't dream of putting patients at risk.

      Posted by Karlene Guay, PT on 3/31/2014 8:24 AM

    • Does anyone know if this affects MAPD plans as well?

      Posted by d h on 4/2/2014 6:19 PM

    • Great post! Been reading a lot about different claims processing situations. Thanks for the info!

      Posted by Claims Processing on 4/29/2014 2:52 PM

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