CMS to Begin Processing Held Claims on April 15


As previously reported, last year’s SGR patch officially expired as of April 1 and a 21-percent cut in reimbursement for physician services is now in effect. CMS previously announced it would hold claims for 14 calendar days to allow the Senate time to pass legislation and complete the SGR fix.

Though the House (in a rare show of bipartisanship) overwhelming passed legislation (H.R. 2) to permanently repeal SGR; the Senate recessed without taking up the measure.  Both California Senators Feinstein and Boxer have stated that they will support the measure.  Congress returned from its two week spring break on April 13.  The Senate has yet to act on H.R.2, so CMS will begin processing claims on Wednesday, April 15, at the reduced rate (a 21-percent decrease) on a first-in, first-out basis. CMS will continue to hold new claims for 14 days; each day one batch will be processed and a new one will be held. The decision to process claims was made to provide continued cash flow to providers, and it is hoped that the “rolling hold” will minimize the need for reprocessing should the Senate pass legislation to retroactively reimburse these claims.

More information about the 2015 Medicare Physician Fee Schedule will be discussed during the next APMA Reimbursement webinar, “Health Policy Regulatory Update,” on Wednesday, April 15, at 10 a.m. PDT.  CPMA Members please log in to register