Medicare Payment Mess

July 3, 2008

Medicare is paying 10.

Medicare is paying 10.6 percent less today than it did on Monday.

Despite last minute wrangling, the Senate did not pass the House-approved Medicare Improvement Act for Patients and Providers (H.R. 6331) which would have halted scheduled cuts to the Medicare physician fee schedule and replaced them with a 0.5 percent increase.

That means the cuts are in effect -- for now.

Once the senators saunter back from their fried chicken holiday picnics, they are expected to reconvene and vote once again. (A procedural oddity allows the bill to be reconsidered.)

Meanwhile, the lobbying is intense, including these TV spots from the AMA. You can lobby, too. The AMA, MGMA, and several specialty organizations have created a unified grassroots hotline. Call 800-833-6354. Or, just call your senator.

So things may yet work out. In the meantime, though, Medicare is going to be holding July claims until at least July 15. It doesn’t want to pay out claims based on the reduced rate, and then have to send out corrections if the Senate changes its mind.

What does this mean for you?

  • You won’t get immediate payment from Medicare for claims submitted this week or next.

  • When you do get paid, it might be under a fee schedule that reflects a 10.5 percent cut or one that reflects a 0.5 percent raise. There’s just no telling.

Crazy, huh?

If it makes you feel any better, senatorial disapproval isn’t aimed at how much physicians are getting paid. They don’t like the proposed changes to the Medicare Advantage program (also included in the bill), one of which stops the practice of “deeming:” automatically putting physicians who see an Advantage patient in the Advantage provider network. Grossly put, many senators associate Medicare Advantage with free-market style competition (never mind that the government pays them 12 percent to 19 percent more than Medicare physicians) and don’t want to see it changed.

Feel differently? Call your senator before the fireworks go off.

Pamela L. Moore is editorial director for Physicians Practice. She can be reached at pmoore@physicianspractice.com.