Part B Insider (Multispecialty) Coding Alert

Published on Fri Aug 18, 2006 PDF

Prepare now for slow end of September

You-re already bracing for the nine days of pain in late September--but the situation may actually be worse than you expect.

The problem: Medicare plans to hold all claims from Sept. 22 through Sept. 30, as required by the Medicare Modernization Act. The Centers for Medicare & Medicaid Services (CMS) had claimed that all of those claims would be paid promptly on Oct. 2. But now it turns out that may not be strictly true.

Some large carriers -may have a little difficulty mailing all of these held payments on a single day,- a CMS official told the Aug. 11 physician open door forum. -Be patient with them,- he pleaded. The carriers- mailrooms may have difficulty sending out that many checks on a single day.

-It might take up to about three days before those checks can get out, but they will all be dated Oct. 2 and ready to go,- the CMS official added.

So it's even more important than ever to prepare for what may turn into 12 lean days. Experts offer the following tips:

- Look at three factors. Whether an office takes special measures will depend on how much Medicare money is in their mix, the anticipated percentage of cash flow drop, and how much cash the office has in reserve, says Marvel Hammer with MJH Consulting in Denver.

- Estimate your shortfall. To get an estimate of how much money you-ll have to go without during the suspension, Hammer recommends that you select a similar nine-day window from the previous year. Then calculate how much Medicare money you got during that time period.

- Keep billing during the slowdown. Although the Medicare payment system is on hold during this period, your billing system shouldn't be, stresses consultant Melinda Gaboury with Healthcare Provider Solutions in Nashville, TN. -Do not discontinue billing for any time period,- she urges.