Congress Passes Bill Protecting Medicare Practitioners from Imminent Fee Cut: CMS to Resume Processing April Claims

Apr 16, 2010

On April 15, 2010, President Obama signed into law the “Continuing Extension Act of 2010.”  The new law extends through May 31, 2010 the zero percent update to the Medicare “Physician” Fee Schedule (MPFS) which was in effect for claims with dates of service from Jan. 1, 2010, through March 31, 2010. The new law is retroactive to April 1, 2010 and will remain in force until the end of May. Without this new stopgap measure, physicians, clinical social workers and other health professionals that bill Medicare Part B independently faced a scheduled rate cut of 21 percent on claims for service delivered after April 1.

The Centers for Medicare & Medicaid Services (CMS) has instructed Medicare contractors to immediately resume processing claims under the new law for services provided by physicians, and non-physician practitioners (NPPs) such as clinical social workers, who are paid under the MPFS. Most claims with dates of service April 1 and later were held by Medicare in anticipation of yesterday’s congressional action. If Congress had not acted, payment rates for claims occurring after April 1, by practitioners who are paid under the MPFS would have been reduced by 21 percent, as required by a formula specified in the Medicare law.

The Medicare MPFS cut was originally scheduled to go into effect for claims paid on or after Jan. 1, 2010, but it was first postponed until March 1 by a provision in the Defense Appropriations Act of 2009, and again until April 1, in the Temporary Extenders Act of 2010. This latest Act extends last year’s payment levels until the end of next month, May 31, at which time Congress plans to again have reached agreement on a longer-term formula solution.


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