A vote in the U.S. House on February 1, 2006 cleared the way for restoration of Medicare physician payments to 2005 levels, halting the 4.4 percent payment cut that took effect Jan. 1. At the request of myriad physician groups, including the Academy of Medicine of Cleveland/Northern Ohio Medical Association (AMC/NOMA) the Centers for Medicare and Medicaid Services (CMS) has agreed to retroactively adjust claims to compensate physicians for the 4.4 percent cut once the one-year payment freeze is signed into law.
To recap the activity that occurred yesterday - the House of Representatives passed the Deficit Reduction Act, which freezes Medicare physician payment rates at 2005 levels and reverses a 4.4 percent payment cut that was implemented on Jan. 1, 2006. Although the freeze in payments is not great news, it could have been worse, given the sweeping budget cuts that Congress enacted as part of the Deficit Reduction Act. After President Bush signs the Act into law, the Centers for Medicare and Medicaid Services (CMS) will reprocess claims submitted since Jan. 1. This will ensure that physicians receive correct payments. President Bush’s signature is expected soon.
The claims adjustment process likely will take several weeks, and physicians do not have to resubmit claims. (For a question and answer sheet regarding claims click here ) In addition, CMS will reopen the 45-day period in which physicians may change their 2006 Medicare participation status. Changes will be retroactive to Jan. 1, and claims will be adjusted to reflect the change in status. Still, Congress has yet to replace the flawed formula with an annual update that reflects practice cost increases. Congress also did not include provisions that would have required physicians to report on quality performance measures, also known as pay-for-performance. Organized medicine and physician groups, including the AMC/NOMA, will continue to push for a long-term solution.