CMS to hold claims for 10 business days; Participation deadline extended

23 December 2009

This week, the president signed into law the Department of Defense Appropriations Bill (H.R. 3326) which will stop the 21.2 percent Medicare physician payment cut until Mar. 1, 2010. Other changes reflected in the 2010 Medicare Physician Fee Schedule final rule will still take effect on Jan. 1, 2010 and may have a slight impact on the conversion factor used for the first two months of 2010. Similar to other years, since congress acted so late in the year to avert the cut, the Centers for Medicare and Medicaid Services (CMS) will hold claims for the first 10 business days of Jan. (Jan. 1 through Jan. 15) for 2010 dates of service to allow its contractors time to update their systems and pay claims based on the updated rates. CMS does not anticipate any cash flow problems for physicians since by law no claims are paid prior to 14 days after receipt.

In addition, CMS has extended the 2010 Annual Participation Enrollment Program end date from Jan. 31, 2010, to Mar. 17, 2010. Physicians still have time to consider their participation options with the Medicare program. Additional information can be found on the American Medical Association’s (AMA) Web site. The effective date for any participation status change during this extension remains Jan. 1, 2010, and will be in force for the entire year. Medicare contractors will accept and process any participation elections or withdrawals made during the extended enrollment period that are received or post-marked on or before Mar. 17, 2010.

This announcement clarifies guidance written prior to the congressional action and sent by CMS on Dec. 21. The AMA has urged CMS to send a follow-up communication to physicians so as to prevent any confusion.