CMS Will Hold January Claims for 10 Business Days in Hopes That the SGR Cut Will Be Delayed Before Payouts Begin

Everyone knows what a mess we’ve had in the past when CMS has had to pay according to the SGR, then it was reversed at the last minute and CMS had to pay additional amounts on services they had considered paid in full – a headache no matter how good your software is.

To avoid that, CMS will hold any claims for 10 business days before re-evaluating based on any change in the Medicare fee schedule for 2012. This will not actually hold anyone’s payments, as Medicare pays their claims in 14 days.

CMS made the following announcement today:

The negative update under current law for the 2012 Medicare Physician Fee Schedule is scheduled to take effect on January 1, 2012, eight business days from today.  Consequently, as on numerous occasions in the past, the Centers for Medicare & Medicaid Services (CMS) will instruct its Medicare claims administration contractors to hold claims containing 2012 services paid under the Medicare Physician Fee Schedule for the first 10 business days of January (i.e., January 1, 2012, through January 17, 2012).  The hold should have minimal impact on provider cash flow because, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt.

Medicare Physician Fee Schedule claims for services rendered on or before December 31, 2011, are unaffected by the 2012 claims hold and will be processed and paid under normal procedures and time frames.

The Administration is disappointed that Congress has failed to pass a solution to eliminate the sustainable growth rate (SGR) formula-driven cuts, and has put payments for health care for Medicare beneficiaries at risk.  We continue to urge Congress to take action to ensure these cuts do not take effect.

I love the way CMS characterizes a 27% cut as a “negative update.” Classic.

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