CMS buys time on Medicare reimbursement cut

Washington - Though Congress adjourned for recess without taking action to forestall the 21 percent cut in Medicare reimbursement that took effect April 1, the Centers for Medicare and Medicaid Services (CMS) has acted to buy doctors more time, MedPage Today reports.

CMS has instructed contractors to hold claims for services performed on or after April 1 for the first 10 business days of the month, allowing Congress time when it returns April 12 to pass legislation pushing back the cut, mandated by Medicare’s sustainable growth rate (SGR) physician-payment formula.

According to a CMS spokeswoman quoted by MedPage Today, the agency is normally not permitted to release payment for 10 business days from the date of receipt, so that if a claim is received on April 1 for a service performed that day, the agency cannot pay it before April 15. However, CMS would normally start processing the claim right away in anticipation of that April 15 release date. But if CMS did that and then Congress changed the law, the agency would have to go back and reprocess those claims based on whatever Congress did - an expensive proposition. “The goal is to avoid paying the claims based on the cut if Congress is going to do something again,” the spokeswoman says.

If Congress does act any time before April 15, CMS will immediately call off the hold and instruct its contractors to start processing again. If Congress does not act, CMS will begin processing the claims on a rolling basis.

On March 10, the Senate passed a bill that would, among other things, delay planned cuts to Medicare reimbursements until Oct. 1, but the House failed to act on the measure.