Payers Scramble to Update Systems
As we reported in a previous article, President Obama signed the Department of Defense appropriations bill into law on Dec. 19, 2009, delaying a 21.2 percent reduction in physician fees until March 1. In response, just days later, the Centers for Medicare & Medicaid Services (CMS) released the January 2010 Physician Fee Schedule (PFS) file that contains the 2010 relative value units (RVUs) and temporary conversion factor.
The amount of time it will take payers to update their systems with the new rates is much greater.
The temporary conversion factor of $36.0846 is effective for Medicare services rendered on or after Jan. 1 through Feb. 28. Unless Congress comes up with another temporary fix or a permanent solution, the 21.2 percent payment cut will go into effect March 1.
Payers are responding to this flip-flopping of rates in different ways. UnitedHealthcare, for example, recently communicated that, while its system is being updated, claims will be paid at the 2009 conversion factor. Payment, however, will not reflect 2010 RVUs or geographic practice cost indices.
“We are expecting updates of relevant fee schedules and anticipate completion by February 27, 2010,” email recipients of the UnitedHealthcare Digest were informed.
UnitedHealthcare says to avoid potential cash flow disruption to physician practices, it will not hold claims for processing during the 60-day limbo. Physicians, however, can alternatively wait to submit claims to UnitedHealthcare until the update process is complete.
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