CMS holds healthcare service claims in anticipation of legislation change

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The Centers for Medicare & Medicaid Services (CMS) has instructed its contractors to hold claims including services paid under the Medicare Physician Fee Schedule (MPFS) for the first 10 business days of January (Jan. 1 through Jan. 15) for 2010 dates of service. According to the agency, the reason for the retention of the claims is the possibility of legislative changes.

Additionally, CMS said it is working with Congress, healthcare providers and the beneficiary community to avoid any disruption in healthcare services and payment of claims for physicians, non-physician practitioners and other providers of services paid under the MPFS, which was scheduled to begin on Jan. 1.

After Jan. 15, the claims will be released and processed under the current law fee schedule. As of now, the current law stands at a negative 21.2 percent processing rate.

Should a new law become enacted during this time period, CMS will process claims under this new legislation or reprocess most claims that may have been processed at the lower rate.

In regard to the holding of the claims, the agency said that due to electronic claims not being paid sooner than 14 calendar days and paper claims not before 29 days after the date of receipt, healthcare providers’ cash flow should not be impacted.

In addition, any service claim delivered on or before Dec. 31, 2009 will not be held and will be paid out under normal operating procedures.

The CMS stated that healthcare providers may choose to hold their own claims until cash flow becomes an issue or when legislation becomes clearer, which may simplify billing and allow providers to work with one payment rather than reconcile two.