Hold off on resubmitting claims affected by recent Medicare payment changes to the physician fee schedule. Some practices might be anxious to recoup money owed because of changes in its favor, but CMS says now is not the time.

The health care reform law forced CMS to make retroactive corrections to the fee schedule. As a result, the conversion factor used in the physician payment formula fell by half a cent. However, physicians in low cost areas will see payments rise because of positive geographic updates to the fee schedule.

The changes are taking some time to implement, but CMS is signaling it is closer to paying claims at the new rate. First, Medicare Administrative Contractors (MACs) will install new files to calculate reimbursements. CMS says MACs will then start paying new claims at the revised or corrected rate. CMS will later notify physicians and practices of how the agency plans to correct claims paid under old rates during the first half of the year.

It's not clear if CMS will require practices to resubmit claims. MACs might be able to make adjustments on their own. But resubmitting claims now will just produce a denial for submitting a duplicate claim, CMS says.

"PPAC has been critical in the past couple years, and it's going to be more critical going forward." Jon Blum, director of CMS's Center for Medicare Management, on March 8, 2010 to open the quarterly Practicing Physicians Advisory Council (PPAC) meeting in Baltimore, Md.

"Therefore, the PPAC is being discontinued and the June meeting will not be held." CMS's PPAC website currently states.

PPAC's input on the Medicare program is no longer required at CMS. The new health care reform law repealed the section of the Social Security Act establishing the 15-member panel of working physicians from around the country. The disbanding falls under the "Focusing CMS Resources on Potentially Overvalued Codes" section of the Patient Protection and Affordable Care Act (PPACA).

Read more on PPAC

A Medicare claim must be submitted within 12 months of the date of service or it will be rejected, CMS states in a transmittal released Friday. The change is mandated by the health care reform law (the Patient Protection and Affordable Care Act or PPACA).

Physicians treating Medicare patients no longer have up to 26 months to file a claim. A claim for a service provided on March 15, 2010 must be submitted for payment by March 15, 2011.

The timely claims change is effective immediately. Claims for services provided before Dec. 31, 2009, will now need to be submitted by Dec. 31, 2010, CMS says. Otherwise sending a claim outside the 12-month window will result in a rejection. The Claim Adjustment Reason Code (CARC) 29 will appear on a remittance when a claim for a service is received a year after the service was rendered. CARC 29 simply means "The time limit for filing has expired."

CMS revised the 2010 conversion factor lower by about half a penny after factoring payment formula changes to the Medicare Physician Fee Schedule.

The new conversion factor for this year is $36.0791, which is just 0.015% lower than the current rate of $36.0846. This is the result of relative value unit (RVU) corrections to the fee schedule and physician reimbursement formula changes mandated by the new health care reform law. 

One reform change in the Patient Protection and Affordable Care Act (PPACA) required CMS to raise payments for physician practice expenses currently being paid below the national rate. As a result, physicians in low-cost states (such as South Carolina and Mississippi) will get higher pay.

Read more on the conversion factor change

The 21.3% cut to Medicare reimbursements set for May 31 is getting national attention. National Public Radio (NPR) listeners were briefed on the cut caused by the sustainable growth rate (SGR) mechanism in the Medicare payment formula during the morning commute on Thursday.

Physician practices might be somewhat relieved this discussion is taking place 25 days before the cut hits. The publicity for this issue is good and there's no such thing as bad press.

This won't be the last you hear about a Medicare payment fix in the national news. Expect medical associations, such as the groups interviewed in the story (the American College of Physicians and American Medical Association), to increase lobbying efforts for a permanent pay fix over the next couple weeks.