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Archive for July, 2010

Congress acts to prevent the 21.3% cut to Medicare payments.

Monday, July 12th, 2010

Congress continues to delay fixing the flawed Sustainable Growth Rate formula. Again, Congress pushed off the 21.3% Medicare cut to doctors pay until 12/1/10. It is believed that this was because Congress doesn’t want to deal with an unpopular pay cut before the elections.

Instead of the cut, a 2.2% increase was passed and is effective retroactively back to June 1. Many Medicare contractors had already begun to process claims at the 21.3% cut for June dates of service, but there is no need to worry because they have been instructed to go back and reprocess underpaid claims. As of 7/8/10, the new June Medicare fee schedule had not been posted on CMS’s website but it should be soon.

The new conversion factor used to calculate payments is $36.8729, which is up from the $36.0791 rate used earlier this year and the $36.0866 rate used in 2009. However, more than 4,000 codes saw a decrease due to a change in Relative Value Units so make sure to review your codes. Congress said it wants fix the SGR formula during this 6-month period before the more than 23% cut goes into effect on 12/1/10.