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MEDICARE
IMPROVEMENTS FOR PATIENTS AND PROVIDERS ACT, 2008
Today, the Centers for
Medicare & Medicaid Services (CMS) announced steps it is taking to implement
certain Medicare provisions in the Medicare Improvements for Patients and
Providers Act of 2008. On Tuesday, July 15 , Congress voted to override the
President's veto of the Medicare Improvements for Patients and Providers Act
(H.R. 6331). The House vote was 383-41, while the Senate voted 70-26 in favor of
enacting H.R. 6331 into law.
As a result, the mid-year 2008
Medicare Physician Fee Schedule (MPFS) rate of -10.6 percent has been replaced
with a 0.5 percent update, retroactive to July 1, 2008.
Physicians, non-physician
practitioners and other providers of services paid under the MPFS should begin
to receive payment at the 0.5 % update rates in approximately 10 business days,
or less. Medicare contractors are currently working to update their payment
system with the new rates.
In the meantime, to avoid a
disruption to the payment of claims for physicians, non-physician practitioners
and other providers of services paid under the MPFS, Medicare contractors will
continue to process the claims that have been on hold on a rolling basis (first
in/first out) for payment at the -10.6% update level. After your local
contractor begins to pay claims at the new 0.5% rate, to the extent possible,
the contractor will begin to automatically reprocess any claims paid at the
lower rates.
Under the Medicare statute,
Medicare pays the lower of submitted charges or the Medicare fee schedule
amount. Claims with dates of service July 1 and later billed with a submitted
charge at least at the level of the January 1 – June 30, 2008, fee schedule
amount will be automatically reprocessed. Any lesser amount will require
providers to contact their local contractor for direction on obtaining
adjustments. Non-participating physicians who submitted unassigned claims at
the reduced nonparticipation amount also will need to request an adjustment.
To read the CMS Fact Sheet at:
http://www.cms.hhs.gov/apps/media/fact_sheets.asp
More information
on physician pay issues is available at
http://www.cms.hhs.gov/PhysicianFeeSched/
More information
on therapy caps is available at
http://www.cms.hhs.gov/TherapyServices/
More information on DME is
available at
http://www.cms.hhs.gov/DMEPOSCompetitiveBid/
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