CMS urges payment delay to defend physician payments

March 1, 2010

It’s a kind of man bites dog story: unusual, remarkable, yet oddly plausible. The Centers for Medicare and Medicaid Services has told its contractors to hold claims containing services paid under the Medicare Physician Fee Schedule for the first 10 business days of March.

It’s a kind of man bites dog story: unusual, remarkable, yet oddly plausible. The Centers for Medicare and Medicaid Services has told its contractors to hold claims containing services paid under the Medicare Physician Fee Schedule for the first 10 business days of March.

On reading this, the cynics among us might think it’s a ploy to buy time for an agency under financial duress, an accounting trick to slow an already lumbering machine so as to eke out a few days of interest by delaying payment. On the contrary, the agency that writes Medicare and Medicaid checks is doing this to help physicians.

Congress won’t be back in session until March 2, a day too late to keep the scheduled 21.2% cut in Medicare payments from going into effect. Legislators should have dealt with this months ago, but they were apparently too busy trying to make healthcare more efficient. Consequently, this political time bomb, looming for months, has ticked to zero. All that’s stopping a deeply flawed sustainable growth rate formula, with its 21.2% across-the-board cuts, from taking effect is a bureaucratic finger jammed in the detonator.

Kudos to CMS and its leaders for having the sense that’s lacking in our elected officials. By asking contractors to hold claims submitted March 1 through 12, CMS is forgoing a savings of 20-plus%, knowing that to do otherwise would throw a wrench into the practice of medicine in this country. It’s buying time for Congress to get its act together and rescind, or at least delay, this cut from going into effect. Congress should have defused this bomb years ago, but didn’t.

In fairness, not all of Congress is at fault. Some members have tried to pass legislation to deal with the problem. The U.S. Senate tried, and failed, to pass HR. 4691, a bill passed by the House that included a 30-day SGR extension. Now if legislators are going to do anything about it, they’ll have to do it retroactively.

It wouldn’t be the first time. Our federal procrastiture (i.e., a legislature that puts things off as long as possible) acted retroactively to rescind a cut scheduled to take effect two years ago. CMS officials say they believe Congress wants to do the same thing again. Along with its request to hold claims for 10 days, the Centers issued the following statement: “We believe Congress is working to avoid the negative update that will take effect March 1, 2010.”

That’s a relief. When looking at recent activities on Capitol Hill, “working” is not the first thing that comes to mind.