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CMS Delays Medicare Claims


Unless Congress eliminated the sustainable growth rate formula, two-thirds of physicians will limit the number of Medicare patients in their practice. $51.70 is just not enough.

The annual tug-of-war over cut in Medicare payments to doctors usually ends with Congress riding to the rescue at the last minute and postponing the cuts for a year. This time around, Congress rewrote the script and, as a result, doctors faced a 21% across-the-board cut in Medicare fees, effective April 1.

The Centers for Medicare and Medicaid Services, however, has given doctors a reprieve, ordering any claims filed on or after April 1 to be held for an additional 10 days before being processed. Coupled with the usual 14-day hold on claims, the additional time means that Congress, which reconvened after its spring recess on April 12, will have time to vote on a further postponement before the claims are processed. CMS officials claim that the hold on claims will have minimum impact on physician cash flow.

This year, the House passed a bill that decoupled Medicare fees from the sustainable growth rate (SGR) formula, which has been the driver of annual fee cut for several years, and that instead ordered annual increases of about 1.2%.

The Senate never considered that bill, but passed one that would postpone the cuts until October 1. The House failed to act on that bill before leaving for its spring break.

Unless Congress rolls back the fee cuts, the Medicare reimbursement for a typical office visit will drop from $65.67 to $51.70, which is far below the cost of providing care, according to the American Medical Association. The AMA claims that more than two-thirds of its members plan to limit the number of Medicare patients in their practice if the fee cuts are allowed to stand.

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