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The RAConteurUPDATE (2/26/2010, 4:23 PM EST): Since my creation of the following post this morning, it has been learned that the Senate has adjourned for the weekend and will not be passing the temporary reduction freeze in time for the Monday deadline.
The latest temporary measure was to be attached to another measure granting an extension of unemployment benefits for 12 million people whose benefits have run out. Jim Bunning, the senior senator from Kentucky currently in his final term, filibustered the bill based on the bill either not having equal cuts in spending to pay for itself or because the funds for the bills would not come from leftover money from an earlier stimulus package. The Democratic majority was unable and/or unwilling to break the filibuster, and the Senate has now adjourned until Monday.
CMS has since issued a press release that states that they are instructing the MAC’s to place a hold on claims for the first 10 business days in March. It is believed that this will provide ample time for Congress to issue another temporary payment fix.
It was 104 years ago today that my grandmother was born in the western suburbs of Philadelphia. Some of the only positive memories I hold of my childhood stem from the time I spent with my grandmother in her kitchen. She had a breakfast table in her kitchen that looked out upon her back yard. Just beyond her backyard was the Route 100 line, that sent trolley cars from 69th Street in Philadelphia to their final destination to the west, in Norristown, with many stops in between. It was easy to get lost in the great potential the world offers a small child standing in her backyard on a sunny day, with the subtlest hint of clouds in the sky and the clickety-clack of the trolley passing every 15 minutes.
My grandmother left this world in April of 1994, In the nearly 16 years since, the memories I’ve carried with me of the time I spent by her side reappear at strange times. It could be the sound of a distant train or the smell of her veal recipe that I still make for my wife and son from time to time. Yet when her memory comes forward, after remembering a funny story or a brief glimmer of a moment in past time when the two of us occupied the same space, the very last thing I feel when such memories arise is loss, and the change in my life that losing this one person brought forward. One can only dance inside their head for an instant before the reality of subtraction appears before them.
Which brings me to today’s urgent topic. Over the past 6 weeks, the medical community has watched with a combination of anger and exhaustion as Congress has failed to definitively act on the issue of the 21.3% decrease in Medicare payments set to take effect this coming Monday. As I type this, yet another piece of legislation has been introduced to delay the pay cut until March 28th, which would create yet another window of opportunity to create a permanent solution to this annual occurrence.
As I described in an earlier post on this topic, we have become desensitized to this process, as a white knight with long flowing hair, cleverly disguised as the latest legislative stay of execution, has until now always arrived in the twilight moments of the latest deadline. With the two days between now and March 1st falling on a weekend, the possibility exists that perhaps this is the time when the knight has either fallen asleep or found other worlds to save.
While it is certainly within the realm of possibility based on past precedent that a temporary pay fix will pass before the Monday deadline, the sobering reality still exists that no fix may be coming. A question immediately appears in my head, wondering how many physicians have truly prepared themselves for this darker eventuality. If someone in this industry takes a moment to imagine the medical delivery landscape in a world where 21% of the largest payer’s receivables suddenly disappear like water vapor, it is more than likely a post-apocalyptic vision.
Lou Reed, with a mix of poetry and a New Yorker’s gift for blunt assessment, once wrote “There’s a bit of magic in everything/and then some loss to even things out”. The healthcare system now finds itself facing an unwelcome loss, while once again hoping for the annual act of prestidigitation that makes a pay cut disappear right in front of your eyes. While those of us involved in the industry can do all we can in the next few days by inundating Congress with faxes and telephone calls demanding a remedy to this situation, be mindful of what this change actually means to our system. Without that awareness, the reimbursement realities of today could become the memories and sense of loss of Monday.
By law, under normal circumstances, electronic claims sent in to Medicare aren’t allowed to be paid for 14 days anyway. Medicare can’t pay them until at least the second half of the month, with or without the hold. What is different is then is that Medicare also won’t be processing claims in the first half of the month, ahead of sending out the payments. If it were to process them, would the pay cut (if it goes through) effect those claims in que once the hold is released?
This hold will create a backlog, anyone recall summer of 2008?
Would that further mean that this hold is nothing more than smokescreen as it effectively does nothing. The A/R of physicians will have then received two more stones to carry around their necks for claims in que.
This is a federal law. Even Congress can’t change that law. However, given the choice perhaps for those physicians that have a large demographic of Medicare patients this is best of two evils.
Actually, by law, CMS can only hold claims for 10 business days. CMS took this step in the hopes that Congress will approve a pay fix that will not saddle physicians with the 21.3% pay cut.
The CMS hold only affects services with a date of March 1, 2010 and after. Claims with dates of service prior to this date will be processed using the existing temporary fee schedule that has been effect since January 1st.
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