Payments on Hold
Below is the latest notice from CMS about the Medicare claims.
There statement that it should have minimum impact on physician cash flow is preposterous.
How many businesses can completely lose 20-70% of its cash flow and not have a problem. It won’t be July 1-15th that is the cash flow problem because that money will be from the two weeks prior. It is going to be July16th to whenever they finally decide to start sending checks that is going to be a real issue.
How about physicians just not treating Medicare patients until July 15th when congress and CMS decides to fix this problem. Or maybe insist that all Medicare patients pay cash and let them get reimbursed later.
I’d bet that would get things done a little quicker!
Fortunately, physicians care more about our patients than to allow that to happen. But many of us will hold off on accepting any new Medicare patients.
Holding Claims Paid Under the Medicare Physician Fee Schedule (MPFS) Joint Signature Memorandum (JSM/TDL-08382) (06-30-08)
“To the extent possible, The Centers for Medicare & Medicaid Services (CMS) is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other providers of services paid under the Medicare physician fee schedule, beginning July 1. In this regard, CMS has instructed its contractors to hold these claims for the first ten business days of July, for dates of service in July.
This should have minimum impact on provider cash flow because, under current law, electronic claims are not paid any sooner than 14 days (29 days for paper claims) after the date of receipt.
Meanwhile, all claims for services delivered on or before June 30 will be processed and paid under normal procedures. After ten business days, contractors will begin releasing claims into processing under the fee schedule which implements current law. This, of course, could result in claims being processed with the negative 10.6 percent update. If a new law is enacted which changes the negative 10.6 percent update, retroactive to July 1, CMS is prepared to automatically reprocess most of those claims which have already been processed.
Under the Medicare statute, Medicare pays the lower of submitted charges and the Medicare fee schedule amount. Claims with dates of service July 1 and later billed with a submitted charge at least at the level of the January 1-June 30, 2008, fee schedule will be automatically reprocessed, if Congress retroactively reinstates the update that was in effect for that time period. Any lesser amount will likely require providers to re-submit a revised claim.
To the extent possible, providers may hold claims in-house until it becomes clearer as to whether new legislation will be enacted or until cash flow becomes problematic. This will reduce the need for providers to reconcile two payments (i.e., the initial claim and the reprocessed claim), and it will simplify provider billings of beneficiary coinsurance and payment calculations for payers which are secondary to Medicare.
In addition, be on the alert for more information about other legislative provisions which may affect you.”
CPT codes, descriptions, and other data only are copyright 2007 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Apply.
There statement that it should have minimum impact on physician cash flow is preposterous.
How many businesses can completely lose 20-70% of its cash flow and not have a problem. It won’t be July 1-15th that is the cash flow problem because that money will be from the two weeks prior. It is going to be July16th to whenever they finally decide to start sending checks that is going to be a real issue.
How about physicians just not treating Medicare patients until July 15th when congress and CMS decides to fix this problem. Or maybe insist that all Medicare patients pay cash and let them get reimbursed later.
I’d bet that would get things done a little quicker!
Fortunately, physicians care more about our patients than to allow that to happen. But many of us will hold off on accepting any new Medicare patients.
Holding Claims Paid Under the Medicare Physician Fee Schedule (MPFS) Joint Signature Memorandum (JSM/TDL-08382) (06-30-08)
“To the extent possible, The Centers for Medicare & Medicaid Services (CMS) is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other providers of services paid under the Medicare physician fee schedule, beginning July 1. In this regard, CMS has instructed its contractors to hold these claims for the first ten business days of July, for dates of service in July.
This should have minimum impact on provider cash flow because, under current law, electronic claims are not paid any sooner than 14 days (29 days for paper claims) after the date of receipt.
Meanwhile, all claims for services delivered on or before June 30 will be processed and paid under normal procedures. After ten business days, contractors will begin releasing claims into processing under the fee schedule which implements current law. This, of course, could result in claims being processed with the negative 10.6 percent update. If a new law is enacted which changes the negative 10.6 percent update, retroactive to July 1, CMS is prepared to automatically reprocess most of those claims which have already been processed.
Under the Medicare statute, Medicare pays the lower of submitted charges and the Medicare fee schedule amount. Claims with dates of service July 1 and later billed with a submitted charge at least at the level of the January 1-June 30, 2008, fee schedule will be automatically reprocessed, if Congress retroactively reinstates the update that was in effect for that time period. Any lesser amount will likely require providers to re-submit a revised claim.
To the extent possible, providers may hold claims in-house until it becomes clearer as to whether new legislation will be enacted or until cash flow becomes problematic. This will reduce the need for providers to reconcile two payments (i.e., the initial claim and the reprocessed claim), and it will simplify provider billings of beneficiary coinsurance and payment calculations for payers which are secondary to Medicare.
In addition, be on the alert for more information about other legislative provisions which may affect you.”
CPT codes, descriptions, and other data only are copyright 2007 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Apply.
Labels: Medicare
posted by Anonymous at 5:55 AM
4 Comments:
With all the whining, you might think that you would see scores of doctors' BMWs and Mercedes parked outside the food stamp offices.
Unfortunately the physicians are not the only people hurt when there is a threat of a decrease in cash flow.
The employees are sometimes asked to wait for their yearly salary increase because "money is tight". And believe me no one that I know who works for a physician drives a BMW or Mercedes.
That anonymous comment is about the silliest reply I have read on this site, and that is saying a lot.
Looks like Senator Kennedy and the Democrats came to your rescue.
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