Medicare Compliance & Reimbursement

The Centers for Medicare & Medicaid Services has delayed until July 15 a 10.6 percent pay cut that was due to hit Medicare providers on July 1. The delay gives Congress time to act to prevent the cuts when it returns from its July Fourth recess, the Associated Press reports.

Kevin Schweers, a spokesman for the Department of Health and Human Services, said Monday the CMS will hold doctors' Medicare claims for services delivered on or after July 1, according to the AP. Claims for services received on before June 30 will be processed as usual, he said.

"By holding claims for health care services that are delivered on or after July 1, CMS will not be making any payments on the 10.6 percent reduction until July 15 at the earliest," Schweers told the AP.

Last week, all eyes were on the U.S. Senate to protect your payments. But last Thursday, the Medicare Improvements for Patients and Providers Act (H.R. 6331) failed a cloture vote in the Senate -- making providers worry the pay cuts would take effect as scheduled, on July 1.

The legislation had passed the House on June 24. Record numbers of House Republicans sided against President Bush by voting for the bill 355-59. In addition to halting the July 1 rate cut, the legislation would have continued the 0.5 percent boost that you received last January and would have increased the conversion factor an additional 1.1 percent for 2009.

But because the House bill relies mainly on Medicare Advantage plan cuts to fund the physician payment boost and other provisions, the Senate would have had to pass companion legislation by a veto-proof majority to overcome the threatened presidential veto. Instead, the Senate failed 58-40 to reach the 60 votes needed to end a filibuster.

The Senate could revisit the rule after the July Fourth recess, thanks to procedural rules, CQ Today reports.

"We'll be back, and you'll have another opportunity to vote for this," Senate Majority Leader Harry Reid (D-NV) told CQ Today.

Carriers will have to comply: If the bill becomes law, carriers will have to adjust their payment formulas so your payments won't be slashed by 10.6 percent.

At this point, whether your carrier will hold your payments until the bill is signed, offer a retroactive payment boost after the bill is signed or institute another method is unclear, says Quin Buechner, MS, M. Div, ACS-FP/GI/PEDS, CPC, CCP, CMSCS of ProActive Consultants in Cumberland, WI.