ASCRS/ASOA
Yesterday afternoon, CMS hosted a private call for the medical specialty societies on the pending 10.6% reduction in Medicare Physician Fees scheduled to take effect on July 1, 2008, and CMS' actions related to this reduction.
Dr. Jeffrey Rich, a CMS official, noted that the agency recognizes Congress' intent to provide relief from the fee cut; however, CMS itself does not have the authority to prevent the reduction. Therefore, to give Congress additional time to take action, CMS will use an administrative tactic and hold claims for 10 business days. This is the maximum amount of time it can hold claims without running into technical difficulties. The hold on claims should not have a significant impact on when claims are actually paid to providers.
Practices who submit claims for fee amounts that reflect the 10.6% reduction, that is, use a conversion factor of $34.0682, will have to resubmit for any additional amount if Congress intervenes and provides a “freeze” for the remainder of 2008. Practices who submit claims that do not reflect the 10.6% reduction, that is, with a conversion factor of $38.0870, which was in effect from January 1, 2008, through June 30, 2008, will automatically be reprocessed by Medicare if Congress provides a freeze for the remainder of 2008.
With respect to co-payments, CMS notes that you should collect co-payments based on what your practice deems is the appropriate amount. If you collect co-payments at the higher amount, that is, the amount that does not reflect the 10.6% cut, and Congress does not intervene, you may have to refund additional monies collected.
If you have any questions, please contact ASCRS’ Government Relations Department at
703-591-2220.