RCPA - Rehabilitation and Community Providers Association


Medicare Payment Update and More
December 9, 2010

Medicare Physician Fee Schedule Fix for December
PCPA learned from the National Council that the US House of Representatives has passed a measure to delay the “negative update” of Medicare that was slated to go into effect in December. The US Senate approved this legislation in mid-November, but the House adjourned for the Thanksgiving holiday before taking action. The Physician Payment and Therapy Relief Act of 2010 (PL 111-286, HR 5712) delays the 23 percent payment reduction through December 31. Congress intends to extend the delay through January 1, 2012 to allow development of a payment system that will not automatically decrease physician payment, but must find offsets for the estimated $300 billion cost over 10 years that is projected for the yearlong delay of Medicare physician payment reductions. The Senate has passed legislation to extend current payment rates through December 2011. The House must act before this becomes law.

File Medicare Claims Within One Year
The Centers for Medicare and Medicaid Services reminds Medicare Fee-for-Service (FFS) providers that the Patient Protection and Affordable Care Act requires all claims for services rendered on or after January 1 must be filed within one calendar year of the date of service. Medicare will deny claims filed in excess of one year from the date the service was provided. Medicare clarified that all Medicare FFS claims for service dates January 1 – December 31, 2009 must be filed by December 31. More information is available in Medicare Learning Network (MLN) Matters articles MM6960 and MM7080.

Ordering/Referring Provider Issues
MLN Special Edition Article #SE1011 informs providers that if Medicare Part B items or services require an ordering/referring provider and the ordering/referring provider is not on the claim, is not a member of the professions permitted to order/refer the item or service, or does not have an enrollment record in the Medicare Provider Enrollment, Chain and Ownership System (PECOS), effective January 3, 2011, the claim will not be paid. More information is available in the article linked above.

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