New Year Heralds Changes to Medicare Physician Fee Schedule

January 13, 2010

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The Centers for Medicare & Medicaid Services (CMS) has instructed its contractors to hold claims containing services paid under the Medicare Physician Fee Schedule (MPFS) until after January 15, 2010 (10 calendar business days), to avoid disruption in the delivery of health care services paid under the new MPFS, which takes effect January 1, 2010.

CMS is prepared to reprocess claims where providers have submitted charges that are greater than the negative 2010 MPFS, which is set at a negative 21.2 percent update. If a new law is enacted that changes the negative update, CMS is prepared to correctly reprocess claims under the new law. Physicians who request charges equal to or less than the 2010 MPFS amount will need to request an adjustment. To the extent possible, providers may hold claims in-house until it becomes clearer whether new legislation will be enacted or until cash flow becomes problematic.

CMS has extended the 2010 Annual Participation Enrollment Program end date from January 31 to March 17, 2010. However, the effective date for any Participation status change during the extension remains January 1, 2010. Contractors will accept and process any Participation elections or withdrawals, made during the extended enrollment period, which are received or post-marked on or before March 17, 2010.