Medicare Claims to be Held for 10 Business Days - Texas Journal of Chiropractic

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Medicare Claims to be Held for 10 Business Days

Published 12/28/2009 - 12:08 p.m. CDT

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Updated Information Regarding the Holding of Claims for Services Paid Under the 2010 Medicare Physician Fee Schedule - This is a clarification to information that was previously posted on the TrailBlazer Web site on December 22, 2009. The President has signed the Department of Defense Appropriations Act of 2010, which provides for a zero percent (0%) update to the 2010 Medicare Physician Fee Schedule (MPFS) for a two month period, January 1, 2010, through February 28, 2010.

CMS is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other providers of services paid under the Medicare physician fee schedule, beginning January 1, 2010. In this regard, CMS has instructed its contractors to hold claims for services paid under the MPFS for up to the first 10 business days of January (January 1 through January 15) for 2010 dates of service. This should have minimum impact on provider cash flow because, by law, clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt. Meanwhile, all claims for services delivered on or before December 31, 2009, will be processed and paid under normal procedures.

The holding of claims allows Medicare contractors time to receive the new, updated payment files and perform necessary testing before paying claims at the new rates. CMS has instructed contractors to begin processing claims at the new rates no later than January 19, 2010. Please note that most contractors are closed on January 18, 2010 (Martin Luther King Day holiday). Therefore, even absent a new update, most claims likely would not have been paid any sooner than January 19, 2010, given the aforementioned statutory 14-day payment floor.

CMS has extended the 2010 Annual Participation Enrollment Program end date from January 31, 2010, to March 17, 2010; therefore, the enrollment period now runs from November 13, 2009, through March 17, 2010.

For further information, refer to the notice at: http://www.trailblazerhealth.com/Tools/Notices.aspx?DomainID=1&ID=13458.

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