Colorado Medical Group Management Association

1) NEW 2008 MEDICARE PHYSICIAN FEE SCHEDULE PAYMENT RATES EFFECTIVE FOR DATES OF SERVICE JULY 1, 2008 THROUGH DECEMBER 31, 2008 (Source: Center for Medicare & Medicaid Services)

The Medicare Improvements for Patients and Providers Act of 2008 was enacted on July 15, 2008. As a result, the mid-year 2008 Medicare Physician Fee Schedule (MPFS) rate of -10.6 percent has been replaced with a 0.5 percent update, retroactive to July 1, 2008.

Physicians, non-physician practitioners and other providers of services paid under the MPFS should begin to receive payment at the 0.5 % update rates in approximately 10 business days, or less. Medicare contractors are currently working to update their payment system with the new rates.

In the meantime, to avoid a disruption to the payment of claims for physicians, non-physician practitioners and other providers of services paid under the MPFS, Medicare contractors will continue to process the claims that have been on hold on a rolling basis (first in/first out) for payment at the -10.6% update level. After your local contractor begins to pay claims at the new 0.5% rate, to the extent possible, the contractor will begin to automatically reprocess any claims paid at the lower rates.

Under the Medicare statute, Medicare pays the lower of submitted charges or the Medicare fee schedule amount. Claims with dates of service July 1 and later billed with a submitted charge at least at the level of the January 1 – June 30, 2008, fee schedule amount will be automatically reprocessed. Any lesser amount will require providers to contact their local contractor for direction on obtaining adjustments. Non-participating physicians who submitted unassigned claims at the reduced nonparticipation amount also will need to request an adjustment.

Contractor websites are being updated with the new rates and these should be available shortly.

Be aware that any published MLN Matters articles affected by the new law will be revised or rescinded as appropriate.

Finally, be on the alert for more information about other legislative provisions which may affect you.

Further instructions regarding other provisions of MIPPA will be forthcoming.

2) CONGRESS OVERRIDES MEDICARE VETO

It has been a banner day of whirlwind activity on the Medicare bill today. The President announced his veto this morning; the House voted 383-41 this afternoon to override, and the Senate just voted 70-26 to do the same.

That means that the 10.6% cut will NOT take effect. Medicare claims will be paid at the 2008 rate schedule thru the end of the year, and a 1.1% increase will take effect Jan. 1, 2009 for the duration of 2009. During these 18 months, we will continue to keep pressure on Congress to revamp the fundamentally broken SGR formula. We simply can't afford to continue this way.

Of special note: Rep. Marilyn Musgrave voted to override the veto, the first time she has done so. This is a significant gesture on her part, and an acknowledgement that she understands the devastating effect the Medicare cut would have on patients and providers in her district. CMS has expressed our profound appreciation to the congresswoman in a statement we released to newspapers in her district this afternoon.

While we have not yet received official word from the Centers for Medicare and Medicaid services, it is our assumption that they will begin processing claims tomorrow (remember, they put a hold on all Medicare claims for the first 10 business days of July). If we learn anything different, we will notify all members and office managers.

Once again, we hope that all of you will take a moment to thank the members of our delegation who voted for the override:
Sen. Salazar
Rep. DeGette
Rep. Musgrave
Rep. Perlmutter
Rep. Salazar
Rep. Udall