Revised Payment Files for the 2010 Medicare Physician Fee Schedule Database (MPFSDB) and Retroactive Provisions under the Patient Protection and Affordable Care Act (Pub. L. 111-148) (the Affordable Care Act)

On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA). One week later, on March 30, the President also signed into law the Health Care and Education Reconciliation Act of 2010. These two new laws have a significant impact on the Medicare Program and many of the provisions have effective dates prior to this point in time. Over the past several weeks, the CMS has begun implementing various provisions of the new laws, including those with past effective dates. In addition to implementing these legislative changes, the Medicare Physician Fee Schedule is being updated to include certain corrections, retroactive to January 1, 2010, as prescribed in recently published notices in the Federal Register.

Once Medicare contractors have the new payment files in place, per the above, all claims going forward will be processed at the revised rates. However, we continue to work on the best way to address the many claims that are paid at the rates that were in place before the current corrections and updates are made. Please be on the alert for further information about how CMS will address past claims. Until then, providers should not resubmit previously-processed claims affected by the payment changes, as it is likely that these resubmissions may be denied as duplicate claims.

Payment files were issued to contractors based on the calendar year (CY) 2010 MPFS Final Rule. Subsequent to the publication of the CY 2010 MPFS Final Rule:

• The Department of Defense Appropriations Act of 2010 provided a two month zero percent update to the 2010 MPFS, effective for dates of service January 1, 2010, through February 28, 2010;
• The Temporary Extension Act of 2010 extended the zero percent update to the 2010 MPFS for dates of service through March 31 2010; and
• The Continuing Extension Act of 2010 extended the zero percent update to the 2010 MPFS for dates of service through May 31, 2010.

 Although the zero percent (0%) update to the 2010 MPFS has been extended through legislation, the conversion factor (CF) has been revised as a result of the PE and MP RVU corrections. The revised CF used in calculating the payment amounts associated with this instruction is $36.0791.