AUTOMATIC 4.4% MEDICARE REDUCTION EFFECTIVE JANUARY 1, 2006; CMS ADVISES DELAYED SUBMISSION TO EXPEDITE PLANNED “ZERO UPDATE”
CMS officials suggested that physicians intentionally delay submitting claims to await passage of the “zero update” feature of the proposed Deficit Reduction Act of 2005.
Following is an excerpt from the BNA Health Care Daily of January 23, 2006:
“Physicians and other providers under the Medicare physician fee schedule should try to hold off submitting their claims until after President Bush signs the budget reconciliation bill that would undo a pay cut, a Centers for Medicare & Medicaid Services official advised Jan. 20. This delay will help CMS avoid reprocessing claims, and physician will not have to receive two reimbursements for the same claims, Stewart Streimer, director of CMS’s Provider Billing Group, said during an Open Door Forum. CMS has already informed physicians that they will not have to resubmit claims. The agency’s goal is to start processing claims correctly two business days after the reconciliation bill — the Deficit Reduction Act of 2005 (S. 1932) — is signed, Streimer said. The agency’s contractors are testing their systems so that they will be able to make the quick switch, he said. The bill contains what has come to be called a “zero update” in the payments to doctors, maintaining the payments at the 2005 level, rather than the reduced level that went into effect on Jan. 1 as the result of the application of a standard formula for payment adjustments. Although the conference report on S. 1932 was passed by the Senate Dec. 20, 2005, Senate Democrats used a parliamentary procedure to send the revised measure back to the House. In the meantime, claims are being made at a rate 4.4 percent less than in 2005, as required by current law. Streimer said that the adjustments will be neither individualized nor made in lump sum reimbursements. Instead, they will be batched and spread out between February and June. The adjustments are expected to be sent out completely by July 1. Providers will receive remittance statements that will show the adjustment amounts.”
