Webinar - After the SGR: What the permanent doc fix means for your practice

Join Daphne Saneholtz and Part B news tomorrow, Wednesday, April 29, 1-2 pm EST, for a webinar entitled "What the permanent doc fix means for your practice". During the one hour discussion, Daphne will help physician practices understand the new payment and reimbursement structure included in the Medicare Access and CHIP Reauthorization Act (MACRA) and explore CMS' emphasis on quality.

Daphne Saneholtz is a partner in Brennan, Manna & Diamond's Columbus, OH office.

CMS to Release Held Medicare Physician Claims April 15

The Centers for Medicare & Medicaid Services (CMS) announced on April 13 that it will release on April 15 Medicare physician claims with dates of service on or after April 1, 2015, that it has been holding . 

According to CMS' MLN Connects Provider eNews Special Edition:

Beginning on April 15th, 2015, CMS will release held MPFS [Medicare Physician Fee Schedule] claims, paying at the reduced rate, based on the negative update, on a first-in, first-out basis, while continuing to hold new claims as they are received.  CMS will release one day's worth of held claims, processing and paying at the rate that reflects the negative update. At the same time, CMS will hold the receipts for that day, thus, continuing to hold 10 days' worth of claims in total. This is to provide continuing cash flow to providers, albeit at the rate that reflects the negative update. This “rolling hold” will help minimize the number of claims requiring reprocessing should Congress pass legislation changing the negative update.

CMS To Hold Physician Claims Hoping for Action on SGR

The Centers for Medicare & Medicaid Services (CMS) recently announced a short-term change to claims processing policy in order to avoid potential disruption and claims reprocessing in the event of congressional action regarding elimination of the Medicare sustained growth rate (SGR) formula. Specifically, CMS is holding claims “for a short period of time” beginning on April 1st.  According to CMS, “[h]olding claims for a short period of time allows CMS to implement any subsequent congressional action while minimizing claims reprocessing and disruption of physician cash flow in the event of legislation addressing the 21% payment reduction.  Under current law, electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt.” CMS intends to provide more information about next steps by April 11, 2015. 

Daphne K. Saneholtz is a partner in the Columbus office of Brennan, Manna & Diamond.