U.S. Senate debate continues over H.R. 4213, the American Jobs and Closing Tax Loopholes Act. In addition to providing another short-term reprieve from the impending Medicare cut, the legislation would increase federal Medicaid funding and extend various expiring programs, such as disaster relief and long-term unemployment insurance benefits.

The Centers for Medicare & Medicaid Services (CMS) previously instructed contractors to hold claims for services paid under the Medicare Physician Fee Schedule (MPFS) through June 17. Today CMS directed contractors to lift the hold and begin processing June 1 and later MPFS claims under the current law’s negative update requirement.
Held claims will be released and processed on a flow basis, first-in/first-out. If Congress changes the negative update currently in effect, CMS is prepared to act expeditiously to make the appropriate changes to Medicare claims processing systems.
Once the House and Senate act to avert the cut, claims will be processed as follows:
  • If the submitted charge is higher than the new rate, the contractor will automatically reprocess the claim.
  • If the submitted charge is lower than the new rate, the physician should call the contractor.
CMS says almost all physicians submit claims for more than the Medicare rates. No one is going to be reviewing the limiting charge for the period that the cut was in place because CMS assumes Congress will ultimately make the fix retroactive.
The Office of Inspector General and CMS are close to releasing a document to waive patient co-pay requirements for situations such as the retroactive increases that were made to the geographic practice cost index increases. CMS will share that document once it is available.