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.