Eli's Rehab Report

Published on Mon Apr 27, 2015 PDF

CMS lends a hand while Congress works out solution.

Panicking about your Medicare claims between April 1 and April 15, 2015? Although Congress didn’t move soon enough to stop the -21 percent cuts to Medicare payments for those few days, your reimbursement is likely in the clear. 

In a special MLN update on April 1, the Centers for Medicare & Medicaid Services (CMS) said it would hold claims for a short period of time beginning on April 1 to limit the impact on Medicare providers and beneficiaries. Word on the street was that CMS would hold claims until April 15.

The hold shouldn’t be an issue since, “under current law, electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt,” CMS said.

Some providers even opted to hold their claims while waiting for Congress to act. “Claims can be held by providers up to one year without penalty,” says Tim Nanof, MSW, director of health care policy and advocacy for the American Speech-Language Hearing Association (ASHA).

“We’re hoping there are not any repercussions,” says Mandy Frohlich, VP of government affairs for the American Physical Therapy Association (APTA). “Since Congress acted [soon] and CMS said it could hold claims up until April 15, we are hopeful that there won’t be any issues with or confusion over claims.”

Left hanging: Experts are still, however, concerned with therapy caps. Even though the caps won an extension to the exceptions process in the SGR repeal legislation, this grace period will last only until the end of 2017.

“Lawmakers can’t just continue to kick the can down the road because it’s costly for providers, and beneficiaries, and it’s a policy that doesn’t make sense for Medicare,” says Tim Casey, director of federal affairs for the American Occupational Therapy Association (AOTA). “Without SGR and physician payment as the biggest elephant in the room, therapists and Medicare beneficiaries could find themselves in a really vulnerable position when that extension runs out.”