Medicare Part B Claims Processing Update

July 2, 2008

RD Medicare providers are among the many healthcare practitioners impacted by recent changes to the Medicare physician fee schedule. The current 2008 Medicare fee schedule was effective until July 1. Since Congress did not pass a legislative fix, rates for all services paid from the physician fee schedule, including MNT for diabetes and non-dialysis kidney disease, will be cut by 10.6%.

As a way to temporarily defer the reduction in fee schedule payments, the Centers for Medicare and Medicaid Services (CMS) has instructed Medicare Administrative Contractors to delay processing any physician or non-physician Medicare claims for health care services during the first 10 business days of July. Claims for services received on or before June 30 will be processed as usual. The delay in processing claims means claims that would have been paid in mid-July will be delayed up to a week. CMS said it will not be making any payments at the 10.6% reduced rate until July 15, at the earliest.

Until Congress fixes the problem, it is possible that providers will see payments at the lower rate. The cuts were scheduled because of a formula that requires fee cuts when spending exceeds established goals. If Congress reaches an agreement on how to reverse the cut, providers will be repaid retroactively through automatically reprocessed claims. However, this will be quite difficult, given the millions of Medicare claims that have to be processed every day.

According to CMS, RDs and other providers may hold claims in-house until it becomes clearer as to whether new legislation will be enacted or until cash flow becomes problematic. This will reduce the need for providers to reconcile two payments (ie, the initial claim and the reprocessed claim), and it will simplify beneficiary coinsurance and payment calculations for payers which are secondary to Medicare. Registered dietitians should refer to their carrier’s web pages for instructions and updated fee schedules.