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| Information regarding the Holding of Claims for Services Paid Under the 2010 Medicare Physician Fee Schedule (200912-27) To the extent possible and in consideration of possible legislative changes, 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 January 1, 2010. In this regard, CMS has instructed its contractors to hold claims containing services paid under the Medicare Physician Fee Schedule (MPFS) for the first 10 business days of January (January 1 through January 15) for 2010 dates of service. This should have minimum impact on provider cash flow because, under current law, clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt. Meanwhile, all claims for services delivered on or before December 31, 2009, will be processed and paid under normal procedures. After 10 business days, contractors will begin releasing held claims into processing under the fee schedule which implements current law. This, of course, could result in claims being processed with the negative 21.2 percent update. If a new law is enacted which changes the negative update effective January 1, CMS will correctly process claims under the new law and, if necessary, CMS is prepared to automatically reprocess most of those claims which have already been processed at the lower rate. Under the Medicare statute, Medicare payments to physicians and other affected providers are based upon the lesser of the actual charge or the MPFS amount. Providers who submit charges that are greater than the negative 2010 MPFS will automatically have their claims reprocessed. Physicians who submit charges that are equal to or less than the 2010 MPFS amount will need to request an adjustment. Submitted charges on claims cannot be altered without a request from the physician/provider. 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. CMS has extended the 2010 Annual Participation Enrollment Program end date from January 31, 2010, to March 17, 2010– therefore, the enrollment period now runs from November 13, 2009, through March 17, 2010. The effective date for any Participation status change during the extension, however, remains January 1, 2010, and will be in force for the entire year. Contractors will accept and process any Participation elections or withdrawals, made during the extended enrollment period that are received or post-marked on or before March 17, 2010. In addition, be on the alert for more information about other legislative provisions which may affect you. |
| Registration and playback for the "On Demand" Medicare University 2009 Virtual Convention has been extended by popular demand to March 31, 2010. National Government Services has extended the availability for registration and playback of the 2009 Medicare University Virtual Convention "On Demand" courses through March 31, 2010. For the low cost of $150, you have access to over 60 unique on-demand courses, not offered through Medicare University, at a time that is convenient for you. Plus, you can earn as many as 57 continuing education units! Visit the Course page on the Medicare University 2009 Virtual Convention Web site to view a list of all the on-demand courses. After March 31, 2010 there is no turning back, so register today at www.NGSMEDICARECONVENTION.com Remember! National Government Services' Jurisdiction B DME MAC List Serve is for out going messages only. Please do not respond back to messages as your response will not be answered, as this is not an authorized mode of communication at this time, Thank you! National Government Services encourages all Web site users to provide feedback regarding ways to improve our Web site. The ForeSee Results (pop-up) survey is an easy mechanism for providers to use to let us know how we can best serve you. Your comments play a large role in the enhancements that are made to the National Government Services Web site. CONFIDENTIALITY NOTICE: This E-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply E-mail and destroy all copies of the original message. To unsubscribe/change profile: click here. |
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