CHA News Article

CMS to Begin Processing Physician Payments at Reduced Rates Absent Senate Action
Senate expected to vote on H.R. 2 this week

In the absence of Senate passage of H.R. 2, the Medicare Access and CHIP Reauthorization Act, current law required the Medicare physician fee schedule (MPFS) to be updated April 1 using the 21 percent rate reduction required by the sustainable growth rate. The Centers for Medicare & Medicaid Services (CMS) took steps to limit the impact on Medicare providers and beneficiaries by holding claims paid under the MPFS with dates of service on and after April 1. However, beginning April 15, CMS must release held MPFS claims. CMS will pay claims at the reduced rate on a first‐in, first‐out basis. Each day, CMS will release one day’s worth of held claims at the reduced rate, while holding the receipts for that day and continuing to hold 10 days’ worth of claims in total. If congressional action is taken to avert the negative update, the Medicare administrative contractors will automatically reprocess those claims paid at the lower rate to reflect the new payment rates. The Senate is expected to take up the legislation this week.