Medicare will hold off processing payment claims until June 18

Congress is debating a bill that would eliminate a cut in Medicare reimbursements to physicians and other providers that officially went into effect June 1. Several news outlets report how the delay in congressional action has created confusion for doctors and Medicare billing procedures.

CQ HealthBeat: "Medicare won't begin processing claims under a reduced payment formula for doctors until June 18, giving Congress a few more days to get its act together. Meanwhile, members of the American Medical Association said they're so upset by Congress dragging its feet that they're sending hundreds of signed white lab coats to lawmakers as part of a new lobbying campaign. AMA President J. James Rohack told reporters at the AMA annual meeting in Chicago that physicians are feeling 'frustration as well as outrage' over the situation. … The 21 percent cut went into effect June 1, but the Centers for Medicare and Medicaid Services has used its administrative authority to delay processing claims for 10 business days, in effect fending off the payment cut through June 14. At issue are claims for services provided June 1 or later. The CMS issued a statement Monday morning saying it is 'hopeful that congressional action will be taken within the next several days to avert the negative update'" (Reichard and Norman, 6/14).

Modern HealthCare: "The CMS first told its contractors in late May to hold claims processed on June 1 and for the first 10 business days after. The House passed legislation on May 28 that replaces the scheduled reduction with positive updates through 2011. But the measure has stalled in the Senate" (DoBias, 6/14).

The Hill's Blog Briefing Room: "The agency had initially delayed processing claims until June 15. A Senate leadership spokesperson said Monday, according to The Hill, that 'Democrats hope to pass the bill — a provision of a larger tax extenders package — by the end of the week'" (Lillis, 6/14).

MedPage Today: CMS spokeswoman Ellen Griffith "said that the delay before doctors get paid should be 'minimal' once CMS begins processing June claims. This will be the fourth time this year that CMS has held claims to save doctors from actually feeling the 21% cut" (Walker, 6/14).

AARP Bulletin: How Congress decides to handle the fix will affect "not only physicians but also millions of patients enrolled in Medicare and TriCare, the health program for military families that ties its payment rates to those of Medicare. … Under a law passed in 1997, Medicare rates for physicians and other providers are calculated under a complex formula that was designed to curb the growth of Medicare costs, but later resulted in cuts so unpopular that Congress has annually postponed them. The legal requirement remains, however, swelling the cuts cumulatively to reach 21 percent this year." Even if Congress approves the latest fix, physicians may still feel the need to limit the number of Medicare patients they treat or opt out of the program altogether unless the current payment formula is repealed. "Nearly one-third of primary care physicians say they have already been forced to cut back on the Medicare patients they see, according to a recent survey of 9,000 doctors conducted by the American Medical Association. More than eight in 10 said it was because of the ongoing threat of future payment cuts" (Barry, 6/14).

Inside Health Policy reports that Sen. Debbie Stabenow, D-Mich., decided to ditch an amendment she proposed that would prevent the Medicare physician payment cut for three-and-a-half years. She did so because physician groups were divided in their support of her amendment (Coughlin, 6/14).