I don’t use the word urgent very often so please take a minute and read this through. This alert is written on December 20, so all information is current as of noon CT on that day. We have 12 days before the Medicare Physician Fee Schedule (MPFS) “negative adjustment” (isn’t that a great way to say drastic cut?) goes into effect.
Executive Summary
Congress has not yet been able to agree upon a freeze of the current MPFS.
This sets the stage for a repeat of 2010 when congress “fixed” this problem five separate times including a retroactive fee increase in the middle of the year.
Only Par providers benefited from the retroactive portion of the fee increase.
You have until the end of the year to change your participation status.
I recommend that if you are currently non-par that you change to par to be able to take advantage of any possible retroactive fee increase.
Detailed Analysis
This is what we know for fact. The House has passed a bill that would have frozen the MPFS at its’ current level for the next two years. That bill was an omnibus bill, which means that it covers a whole lot of different issues that need to get done before the end of the year. As such, it contained elements that the Senate did not like and they did not pass the bill. The Senate passed a bill that would freeze the MPFS for the next two months. This difference has to be reconciled before the bill can go to the President for his signature and go into effect.
My sources in Washington tell me that the House will reject the Senates two-month extension and vote to put the question in conference. The Senate now has to re-convene to vote to go to conference, the conference committee has to meet and a compromise solution has to be agreed upon. With Congress about to recess for the rest of the year, it is uncertain if they will reach an agreement before the MPFS cut goes into effect. CMS has issued a directive to the carriers and MACs to hold all claims for the first 10 business days of the year (January 1 thru January 17) to give Congress time to act. This sets the stage for a repeat of 2010 when Congress froze the MPFS cut five separate times and retroactively raised the MPFS 2% in the middle of the year.
How Does This Affect You?
In 2010 Congress enacted a retroactive 2% increase to the MPFS. Those providers that were Participating Providers and were billing Medicare their full fee were automatically paid this 2% increase. Those providers that were not participating or did not bill their full fee to Medicare did not receive the retroactive portion of the increase. If you are a non-participating provider you have until the end of December to change your participation status.
Recommended Action
I recommend that you become a participating provider with Medicare if you are not already. Participation means that you will accept assignment on all Medicare claims for the year. Non-participation does not provide you with any protection from audits or reviews or from refunding overpayments. I have attached the form CMS-460 Participation Agreement for your convenience. I recommend that you act quickly.
Dr. Ron Short, DC, MCS-P Heartland Consulting Group 217-285-2300 ChiroMedicare@gmail.com
Save time with simple, fast code searching. Eliminate coding frustrations by getting the timely answers you need. Avoid denials and lost payments with current, up-to-date information. Improve your office's bottom line. Enhance your skills as a coder.
Home |