The Medicare Physician Fee Schedule (MPFS) was updated using the Sustainable Growth Rate (SGR) Methodology as required by law. Beginning April 1, 2015, the SGR methodology required a 21% decrease in MPFS payments.
CMS took steps to limit the impact on Medicare providers and beneficiaries by holding claims paid under the MPFS with dates of services on and after April 1, 2015. Medicare is also holding therapy claims that no longer qualify for the therapy cap exceptions due to the expiration of the therapy cap exceptions process on April 1, 2015. In an effort to avert the negative update, “CMS must update payment systems to comply with the law, and implement the negative update.”
“Beginning on April 15th, 2015, CMS will release held MPFS claims, paying at the reduced rate, based on the negative update, on a first-in, first-out basis, while continuing to hold new claims as they are received. CMS will release one day’s worth of held claims, processing and paying at the rate that reflects the negative update. At the same time, CMS will hold the receipts for that day, thus, continuing to hold 10 days’ worth of claims in total. This is to provide continuing cash flow to providers, albeit at the rate that reflects the negative update. This “rolling hold” will help minimize the number of claims requiring reprocessing should Congress pass legislation changing the negative update.”
Please be aware that claims for services furnished on or before March 31, 2015 are not affected by the payment cut and will still be processed and paid under normal time frames.
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*Information provided by NGS.