CMS to Implement 27% Doc Payment Cuts

The Centers for Medicare and Medicaid Services (CMS) has announced tentative plans on how to handle 2013 Medicare claims in the absence of Congress providing a “doc fix.” “Given the current progress with the legislation, CMS must take steps to implement the negative update, ” stated a recent CMS update.

Under current law, physicians will receive a 27% cut in the Medicare Physician Fee Schedule on January 1, 2013. As of this writing, Congress and the President were still wrangling over the sequestration law. Both sides have reportedly said any “doc fix” should be part of a broader agreement on the federal budget.

CMS reminds physicians that claims for services rendered on or before December 31, 2012, are unaffected by the 2013 payment cut and will be processed and paid under normal procedures and time frames.

But after January 1, 2013, all bets are off. Last year, mandatory cuts went into effect, but Medicare held off processing claims until Congress came through with a one-year patch. CMS is not doing that this year.

January 11 Update Promised

Currently, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt. CMS will notify physicians on or before January 11, 2013, with more information about the status of Congressional action to avert the negative update and next steps.

Tim Hunter, vice president, health economics, reimbursement & public policy for MCRA, LLC (Musculoskeletal Clinical Regulatory Advisers, LLC), told OTW that if there is not a Congressional temporary fix or patch in place by mid-January, physicians once again face administrative complications with respect to timely and full remuneration for their services. “If CMS holds claims, then payments are delayed; if CMS processes claims based upon the 27% cut and then retroactively re-adjudicates based upon the temporary patch, physicians may incur additional administrative burdens to ensure that full payment is received. Either way, it is disruptive to practices.”