Retroactive Change to Part B Fee Schedules, effective 1/1/10 - 5/31/10
The Centers for Medicare and Medicaid Services (CMS) have revised the Part B payment files to incorporate changes to payments as a result of a Calendar Year 2010 (CY 2010) correction notice and changes resulting from the Patient Protection and Affordable Health Care Act (see link on left for revised schedule). These changes resulted in a modification to the conversion factor for claims provided from January 1, 2010 through May 31, 2010. Recently submitted claims have been paid at these new rates, although it is currently unclear how retroactive adjustments will be handled. Below is a more detailed update, directly from the CMS website, in regard to the continually changing fee schedules.
From the CMS Website:
CY 2010 Physician Fee Schedule Update
On December 19, 2009, the Department of Defense Appropriations Act, 2010 (Pub. L. 111-118) was signed into law. Section 1011 of Pub. L. 111-118 provided a 2-month zero percent update to the CY 2010 Medicare physician fee schedule (PFS) effective only for dates of service from January 1, 2010 through February 28, 2010.
Further, on March 2, 2010, the Temporary Extension Act of 2010 (Pub. L. 111-144) was signed into law. Section 2 of Pub. L. 111-144 extended through March 31, 2010 the zero percent update to the PFS that was in effect for claims with dates of service from January 1, 2010 through February 28, 2010.
In addition, on April 15, 2010, the Continuing Extension Act of 2010 (Pub. L. 111-157) was signed into law. Section 4 of Pub. L. 111-157 extended through May 31, 2010 the zero percent update to the PFS that was in effect for claims with dates of services from January 1, 2010 through March 31, 2010.
Therefore, for services provided from January 1, 2010 through May 31, 2010, the PFS update remains at zero.
Finally, we note that on May 10, 2010, revised payment files for physician claims were released to Medicare Contractors. These revised payment files incorporate changes to payments as a result of the CY 2010 correction notice (on display at the Federal Register on May 5, 2010) and changes resulting from the Patient Protection and Affordable Health Care Act. These changes also result in a change to the conversion factor for claims provided from January 1, 2010 through May 31, 2010. The resulting conversion factor applicable to services provided during this time period is $36.0791.
Instructions regarding the reprocessing of claims paid prior to the implementation of these revised files will be forthcoming. Please watch your listserv and contractor's website for more information.
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The "Temporary Extension Act of 2010" Extends the Zero Percent Medicare Physician Fee Schedule Update
On March 2, 2010, President Obama signed into law the "Temporary Extension Act of 2010." Among other things, this law extends through March 31, 2010, the zero percent update to the Medicare Physician Fee Schedule that was in effect for claims with dates of service January 1, 2010, through February 28, 2010. Consequently, effective immediately, claims with dates of service March 1 and later which were being held by Medicare contractors will be released for processing and payment. Please keep in mind that the statutory payment floors still apply and, therefore, clean electronic claims cannot be paid before 14 calendar days after the date they are received by Medicare contractors (29 calendar days for clean paper claims).
Please watch your listserv and contractor's website for more information about the new legislation.
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Please feel free to contact us if you have any questions on these changes.