Physician pay
As a result of the new law, the mid-year 2008 Medicare Physician Fee Schedule rate reduction of -10.6 percent is retroactively replaced with the fee schedule rates in effect from January to June 2008, which reflected a 0.5 percent update from 2007 rates. In addition, MPFS payment rates are being revised to increase the fee schedule amounts for certain mental health services. Effective immediately, CMS has instructed its contractors to implement the new law. However, it may take up to 10 business days to implement these changes. To minimize physician disruption during this transition, CMS will post the new physician fee schedule as soon as possible and will continue its rolling 10-day hold and release of claims. This means that, until the new fee schedule rates are implemented, some claims may still be paid at the lower rates that were in effect between July 1 and July 15. To the extent possible, contractors will begin to automatically reprocess any claims paid at the lower rates in a timely manner. CMS is expected to issue guidance about the collection of corrected co-insurance payments shortly; read more here.
Therapy caps
The law also reinstated the therapy caps exceptions process as of July 1. Therefore, medically necessary therapy services in excess of the therapy caps will continue to be paid by Medicare in accordance with the exceptions process. Read more about therapy caps.
DME
The Durable Medical Equipment Competitive Bidding Program, which affects only Medicare beneficiaries in traditional fee-for-service in 10 competitive bidding areas, has been delayed. Medicare beneficiaries may use any Medicare-approved supplier for Durable Medical Equipment. If a beneficiary changed suppliers when this new program started (July 1), they can either continue to use the new supplier or choose another supplier. The original DME payment rates in effect before July 1 are reinstated retroactively. Get more information on payment rates and claims processing.
