Part B Insider (Multispecialty) Coding Alert

Published on Wed Feb 22, 2006 PDF

Don't worry about collecting extra copayments from patients, CMS advises

Hang in there--there are only a couple more weeks of cut-to-the-bone payments to endure.

The House of Representatives will vote on the final 2006 budget package on Feb. 1, according to press reports. House Speaker Dennis Hastert (R-IL) has tentatively slated the vote for that day. The final budget bill includes a payment freeze for physicians, but leaves out any pay-for-performance measures.

In a Jan. 6 letter to Rep. Bill Thomas (R-CA), Centers for Medicare & Medicaid Services official Herb Kuhn assures that CMS will be ready to restore the 2005 payment rates as soon as Congress replaces the 4.4-percent cut with a zero-percent update.  CMS will tell your carrier to reprocess the claims it has already processed with the 4.4-percent cut. "Physicians and other providers will not need to resubmit their claims," Kuhn says.

What will happen: The carriers will phase in the reprocessing of the claims, and all claims should be reprocessed no later than July 1, Kuhn promises. You'll receive one lump sum payment for the difference between the 4.4-percent cut and the freeze for all your January claims.

And you probably won't have to collect any additional copayments from your patients, Kuhn adds. CMS has consulted with the HHS Office of Inspector General, and believes that waiving the extra copayments from those January claims would be unlikely to sway patients into using your services. Medicare will forward claims to Medigap insurers and other secondary insurers, but you may have to bill them separately for any extra amount, Kuhn says.

CMS will allow an extra 45-day enrollment period for any physicians who didn't want to enroll in Medicare with the 4.4-percent cut but want to enroll under the freeze. These enrollments will be retroactive to January 1, Kuhn says.