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URGENT - MEDICARE FEE SCHEDULE ISSUE


A message from The New York County Medical Society – December 20, 2012

MEDICARE: WILL WE GET STEEP CUTS?
WHAT FEE SCHEDULE SHOULD YOU USE?

Inconceivably, physicians are once again watching Congress closely and hoping their legislators will not shirk their responsibility to prevent steep Medicare physician payment cuts. This time, a 26.5% Medicare cut (the “negative update”) is scheduled for January 1, 2013, and the threat is growing each day that Congress may fail to act in time - deferring action until after cuts have already been enacted in 2013. This is unconscionable! And meanwhile, you have questions about what to do about your claims and what Medicare fee schedule to use!

HERE’S WHAT TO DO ABOUT YOUR CLAIMS.

Your claims this month: Send them in. Medicare Physician Fee Schedule 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. So, just send these claims in.

Your claims early in January: We recommend that you hold them until at least January 12, 2013, pending further clarification from Congress. With the legislative solution blocked for now, CMS is taking steps to implement the negative update. But: CMS has just sent physicians a memo reminding them that clean claims don’t get paid sooner than 14 calendar days (electronic) or 29 days (paper claims) after the date of receipt, and saying, “CMS will notify you on or before January 11, 2013, with more information about the status of Congressional action to avert the negative update and next steps.” What does this mean? It strongly implies: If you were to send in your early January claims they’d be on hold anyway, after which you might get into all sorts of administrative complications. With this in mind, it may be a better idea for you to hold the claims instead. CMS will send more information and instructions on or before January 11, 2013, and as more information becomes available we will keep you posted.

HERE’S WHAT TO DO ABOUT THE POLITICAL PROBLEM.

Demand that Congress act before January 1, 2013. Contact your Representative and Senators Schumer and Gillibrand, calling their offices using the AMA grassroots hotline at 1-800-833-6354, and sending them an email from the MSSNY Grassroots Action Center at http://capwiz.com/mssny/issues/alert/?alertid=62146506&type=CO&show_alert=1.

Remind them that failure to permanently address this annual problem perpetuates the threat of cuts, creating instability for physicians' practices, eroding their confidence in the Medicare system, and limiting access to care for patients. Remind them also that these cuts threaten employment for many who work in physician offices.

As recently as 2010, Congress allowed cuts to occur and then fixed the interruption in Medicare physician payments at a later date. Our federal representatives must be reminded that this action caused a disruptive hold on claims for Medicare physician services, creating significant strain for physician practices and interrupting access to care for Medicare beneficiaries. If Congress once again defers action on the scheduled Medicare SGR cuts until after Jan. 1, it will be at a great cost to physicians and their patients. It's time for the delays, short-term patches, and partisan games to come to an end.


Posted 12-20-2012 at 12:15PM

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