As Congress Struggles, CMS Resumes Processing Medicare Claims

Jun 21, 2010

Faced with several more days of congressional debate, the Centers for Medicare and Medicaid Services (CMS) has begun processing payments for Medicare Part B claims for services delivered beginning June 1, 2010 and afterward, including those of physicians and clinical social workers. For the third time this year, Congress has been stymied in its efforts to pass legislation that would prevent a scheduled Medicare Part B fee reduction of 21 percent. Medicare payments to clinical social workers during this period will reflect a 21 percent cut below the amount paid in May.


Congress is well aware of the fee confusion and frustration of Medicare providers and is making progress toward completion of a short-term solution. On Thursday, June 17, 2010, the Senate passed a six-month agreement to reverse the 21 percent cut in outpatient provider fees paid by Medicare. This new bill will be considered and likely  passed on Tuesday, June 22. To speed Senate passage, this new Medicare measure was removed from larger extenders legislation (H.R. 4213); see our recent extender alert here. The now separated Medicare fee provision will be considered in the House as H.R. 3962.


The new Medicare bill provides $6.4 billion to undo the 21 percent cut in Part B payments that has already gone into effect. When passed, the fee reversal will require CMS to reprocess all reduced claims at the fully restored amount. The new Medicare bill is fully offset by savings in Medicare billing regulations, anti-fraud provisions and the tightening of some pension rules, thus overcoming Republican objections that it would put the federal government deeper into debt. Meanwhile the Senate remains deadlocked on the larger extenders bill, H.R. 4213, which still contains Medicaid, Unemployment Insurance, and TANF Emergency Funds supported by NASW.