On June 25, the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010” was signed into law establishing a 2.2% update to Medicare physician fees retroactive from June 1 through November 30, 2010. Previously this year, the 5% bump in payments for psychotherapy codes that had been in place in 2008 and 2009 was reinstated retroactive to January 1, 2010. Unfortunately, the fees currently posted on Medicare Carrier and Administrative Contractor websites do not yet reflect the 2.2% boost in fees because there is a lag time while they test their systems’ ability to process claims at the new amounts.
Until the contract websites post fees dated June 1 through November 30, 2010, based on discussions with CMS staff, the APA is advising its members who submit claims for services that occurred June 1 and later to calculate the amount due them as 3% more than the amount listed on their Medicare contractor's website. The reason for this is that by law Medicare payments to physicians paid under the Medicare Physician Fee Schedule (MPFS) are based upon the lesser of the submitted charge on the claim or the MPFS amount. If the claim you submit is for less than you are entitled to, you will be paid the lesser amount—and the only way you can have this corrected is by contacting your Medicare contractor and requesting an adjustment. Since we know how difficult it can be to contact Medicare contractors, we think it's best to bill in a way that obviates the need to have claims reprocessed. There is no penalty for billing higher than the allowed amount. Once the fees posted are current, you can just use the ones you find on your contractor's website.
Contact Ellen Jaffe, Office of Healthcare Systems & Financing, for more information ejaffe@psych.org, 703.907.8591.
________________________________________________________
SAVE THE DATES: CMS Education Series for Providers on the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs
The Centers for Medicare & Medicaid Services (CMS) will provide a series of national provider calls addressing the specifics of the Medicare and Medicaid EHR incentive programs for hospitals and individual practitioners. Learn the specifics on
- who is eligible,
how much are the incentives and how are they calculated,
what you need to do to get started,
when the program begins and other major milestones regarding participation and payment,
how to report on Meaningful Use measures
where to find helpful resources and more.