Holding of June 2010 claims for services paid under the 2010 MPFS

Congress failed to address this year’s Medicare physician payment cut before the June 1 deadline this week. Although the U.S. House of Representatives passed legislation at the last minute to suspend cuts for another 19 months, the U.S. Senate left for Memorial Day recess without taking action. When Congress returns from their vacation on June 7, the Senate is expected to take up the House-passed bill.

The new proposal being considered by Congress would provide payment updates of 2.2 percent for the remainder of 2010 and an additional 1 percent increase in 2011. However, in 2012 the SGR formula will once again go into effect and payments will be cut by an estimated 33 percent.

The Continuing Extension Act of 2010, enacted on April 15 extended the zero percent (0%) update to the 2010 Medicare physician fee schedule (MPFS) through May 31. CMS believes Congress is working to avert the negative update scheduled to take effect June 1. To avoid disruption in the delivery of health care services to beneficiaries and payment of claims for physicians, nonphysician practitioners, and other providers of services paid under the MPFS, CMS has instructed contractors to hold claims containing services paid under the MPFS (including anesthesia services) for the first 10 business days of June. This hold will only affect MPFS claims with dates of service June 1 and later.

This hold should have minimum impact on provider cash flow because, under the current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt. Be on the alert for more information about the 2010 MPFS update.