REIMBURSEMENT:
Top 10 Payment Changes In The New Deficit Reduction Act
Published on Thu Feb 02, 2006
Medicare providers get to start the 2006 claims year all over again.
The intense Congressional volley that prolonged the budget reconciliation bill's enactment is over, and the new Deficit Reduction Act's rollout has begun. But providers awaiting their claims adjustment checks could still have a long wait ahead.
The DRA's new provisions have many providers breathing a small sigh of relief. The American Academy of Family Physicians applauds the Centers for Medicare & Medicaid Services for agreeing to restore physicians' Medicare payments retroactively, but notes that the tug-of-war between the agency and physicians cannot continue. "[W]e cannot go on year after year with this battle. We can't be satisfied with breaking even or a small percent increase each year," AAFP president Larry Fields pleads in a statement. "Congress needs to fulfill its obligation to fix this problem so that our patients have access to quality care. Until Congress acts, they are putting their constituents and our patients at risk."
Key Payment Changes Begin Immediately
The DRA makes many changes and adjustments to Medicare reimbursements and rental agreements, all of which stand to relieve some providers and benes--and frustrate others. Watch out for these key payment changes that are now in effect.
1. Physician payments. The DRA reverses the 4.4-percent physician payment reduction that went into effect Jan. 1, 2006. Medicare contractors began paying new claims without the 4.4-percent reduction within two days of the DRA's passing.
Contractors will reprocess January claims that they already filed and issue payment adjustments by July 1, 2006. Contractors will make one or more aggregate payments by that time, rather than reprocessing reimbursements on a claim-by-claim basis. Most Medigap plans and secondary insurers will also be able to reprocess claims automatically, but some secondary insurers may require resubmission.
CMS recognizes that the physician payment changes may affect providers' decisions to participate in Medicare. Providers have a 45-day window from Feb. 15 through March 31 to reconsider their Medicare participation for the 2006 plan year. Participation changes will be retroactive to Jan. 1, 2006.
2. Claims payments. The act extends the minimum number of days Medicare has to pay non-electronic claims from 27 days to 29 days.
3. Outpatient therapy payments. The act requires CMS to establish an exceptions process that permits payments for outpatient therapy services to exceed payment caps when those services are "medically justified." Two separate $1,740 payment caps went into effect Jan. 1, for occupational therapy services and for combined services relating to physical therapy and speech-language pathology. Look for more information about the exceptions process in next week's issue of MLR.
4. SNF bad debt payments. The DRA reduces Medicare bad debt reimbursements to skilled nursing facilities to 70 percent of benes' unpaid coinsurance (with the exception of dual eligible benes). [...]
