Neurology & Pain Management Coding Alert

Question: Is there any updated news about Medicare's changes to the physician fee schedule and the 4.4 percent pay cut?


New York Subscriber

Answer: Neurologists, like other providers nationwide, have finally gotten some assurance that you will see relief from the 4.4 percent dip in payment initially proposed by the Deficit Reduction Act. Even though the pay cut went into effect automatically on Jan. 1, Congress is soon expected to pass a 0 percent change to 2005 pay levels.

The good news doesn't end there. According to a recent announcement, CMS will instruct contractors to automatically process new claims and reprocess existing claims to reflect the legislation's 0 percent physician payment update.

You will not need to resubmit existing claims submitted between Jan. 1, 2006, and the legislation's enactment. Contractors will automatically reprocess any claims that used the 4.4 percent pay reduction with the 0 percent update retroactive to Jan. 1.

CMS expects contractors to begin paying new claims using the 0 percent update within two days of the legislation's enactment. Because contractors process about 20 million claims per week, however, the turnaround time for reprocessing existing claims will depend on the volume with each contractor.

The check is in the mail: CMS estimates that contractors should be able to reprocess all claims by July 1, 2006. Providers will receive retroactive payment for the 4.4 percent differential in a lump sum.