Essential HealthCare Solutions

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Possible Cash Flow Problems for Providers As many of you already know, no action has been taken on enacting a fix to the SGR (Sustainable Growth Rate) problem prior to June 14th. Beginning on June 14th, medical providers should expect that the claims which have been held since June 1st, will begin to be processed and payments for those Part B claims will be at the 21.3% reduced payment level. Both the House and Senate are working on legislation which will fix the SGR problem but it will be impossible for them to complete any action on the specific legislation and get a bill to the President to sign prior to Monday, June 14th. It still is anticipated that Congress will eventually pass legislation to restore the full payments for all claims from June 1st, it is not clear when or even how much the payments will be. Congress is focusing their efforts on enacting an SGR fix for a longer period of time, 18 months out, instead of the 1 or 2 month fix that currently has been happening. When this "fix" does occur, it is still unclear how the claims will be reprocessed by CMS. CMS has not given any indication as to whether the claims will be automatically reprocessed and the additional payment will be received without any further action or if claims will have to be resubmitted to obtain the full payment due. In addition, this also complicates the task of collecting copays from Medicare patients as well. The copay is 20% of the allowable Medicare fee schedule, so because the fee is decreasing, the copay will decrease as well. If the fix does not happen soon, providers are going to have to collect reduced copay as well for the services rendered. If the reduction is fixed, then patients (or even their secondary insurances) will have to be re-billed at the new rate. Essential Healthcare Solutions will continue to submit claims as they have been doing and will follow the rules CMS puts forward regarding this issue. When payment is released, EHS reminds you that it will be at the reduced rate. If you have any questions, please give us a call at (801) 593-9223 EMAIL: info@reaching4solutions.com CMS Continues Holding Claims through June 17, 2010 This morning the Centers for Medicare & Medicaid Services released the following announcement: The Continuing Extension Act of 2010, enacted on April 15, 2010, extended the zero percent (0%) update to the 2010 Medicare Physician Fee Schedule (MPFS) through May 31, 2010. At this time, Congress is debating the elimination of the negative update that took effect June 1, 2010. The Centers for Medicare & Medicaid Services (CMS) is hopeful that Congressional action will be taken within the next several days to avert the negative update. To avoid disruption in the delivery of health care services to beneficiaries and payment of claims for physicians, non-physician practitioners, and other providers paid under the MPFS, CMS had instructed its contractors on May 27th to hold claims for services paid under the MPFS for the first 10 business days of June (i.e., through June 14, 2010). This hold only affects MPFS claims with dates of service of June 1, 2010, and later.

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