21% Medicare cut averted!

Congress raises Medicare payments by 2.2% thru November 30th....21% cut averted.

The House voted late tonight (June 24th) to adopt a Senate-passed Medicare physician pay increase of 2.2% through November 30th, 2010, temporarily reversing the 21% cut Medicare contractors began applying to claims earlier this week.

It is unknown at this time how the unpaid claims will be processed until CMS provides carriers with direction. When this has been determined, it will be posted.

Unfortunately this fix is just until November 30,2010, which means on December 1st, we may see a 23% decrease in the fee schedule.

A note of interest is that the House voted 417-1 to pass the measure after the Senate confirmed it unanimously. The person voting against it was Democrat Congressman George Miller of California - hope you never get sick, George!

June Medicare Claims Released for Processing

Medicare claims for June previously being "held" by carriers have been released - fee schedule slashed! Be prepared for unnreasonable reductions in your payments.

On June 18th CMS directed contractors to lift the hold and begin processing June 1st and later claims under the law's negative update requirement. Held claims will be released and processed on a flow basis, first-in / first-out. These "held" claims will reflect the negative update requirement and providers should see payments at approximate 21% less they had been paid.

Please know that the negative fee schedule update will ONLY be applied with dates of service June 1st and later. Claims with a DOS prior to June 1st will be processed at the rate which was in effect as of January 1,2010.

Congress continues to debate the elimination of the negative update that took effect June 1st. CMS is "hopeful" that Congressional action will be taken to avert the negative update and will continue to monitor those actions.

If Congress changes the negative update currently in effect, CMS is prepared to act quickly to make the appropriate changes to the Medicare claims processing system.

June Medicare Claims - Still on Hold

CMS DIRECTS CARRIERS TO CONTINUE HOLDING JUNE CLAIMS

At this time, Congress is debating the elimination of the negative update that took effect June 1, 2010.

The Centers for Medicare & Medicaid Services (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.

Part 2: HIGLAS to Effect Cash Flow - End of July - 1st of August

Medicare Payments to be received earlier

just for a short time.

As an earlier post indicates, WPS will install a new standardized accounting system called HIGLAS. In order to install the system, WPS must reduce the payment floor for both paper and electronic claims to zero. Payments will be released early for claims that have already been approved for payment. The payment floor reduction begins on July 28, 2010 and goes through July 30, 2010.

It's planned that on approximately August 6th, there should be no claims left in the system so that the transition can take place. On August 9, 2010, the payment floor will be reset to 29 days for paper and 14 days for electronic claims.

This is what you need to remember! This temporary reduction of the payment floor will result in payments being issued EARLY (both checks and EFT's). This may give the appearance that your cash revenues have increased, when in fact you have just received your payments early.

Providers are encouraged to monitor their payments and make necessary adjustments as necessary to prevent cash flow problems during the transition period. Since payments will be issued early - there will be a period of time after the early payments that you will not be receiving any payments.

E-Prescribing of Controlled Substances Not Allowed Yet in Iowa

E-prescribing of controlled substances

in Iowa

All providers who have a federal DEA number should have recently received a letter from the FDA regarding the ability to electronically prescribe controlled substances. The letter stipulates that under certain conditions this is allowable if your computer system meets certain criteria.

Please be aware that Iowa law currently does not authorize e-prescribing of controlled substances. Rule review and amendment to address this issue is forthcoming but the Pharmacy Board does not anticipate changes for at least 3 or 4 months.