Medicare Claim Hold on Hold

Repeat of 2010 Coming Soon?

Because of last minute action by both houses of Congress, the planned 10-day hold on all claims, effective January  1, 2012, is not in effect. The reason for the hold was to give Congress the opportunity to implement another “Doc Fix,” that is, to adjust the pending 2012 Medicare Physician Fee Schedule so that it did not impose the 25% fee cut mandated by the Sustainable Growth Rate (SGR) formula. It was not certain that Congress would take action prior to the Christmas break. Had claims been processed at the reduced fee schedule starting at the first of the month, they would have to have been re-processed, hence the hold was set to give time for the issue to be settled. As Congress acted, no hold was required. The Medicare Physician Fee Schedule will be held at the current rates until March 1, 2012. However, certain practitioners in certain areas may still see a change in reimbursement. This is because the Relative Value Units (RVU) may have been modified.

On numerous occasions in the past, particularly in the year 2010, the Centers for Medicare & Medicaid Services (CMS) has adjusted the Fee Schedule more than once in the year. This puts PAR providers at an advantage, because if a change is made retroactively, PAR providers will be updated automatically. (CMS has moved the deadline for selecting PAR status back to February 14th, 2012.) Further, non-PAR providers must strictly adhere to Limiting Charges for services. If the fee schedule is frequently updated, the odds of submitting the wrong charge on a claim are higher, the penalties for which are steep.