The Centers for Medicare & Medicaid Services is planning to pause claims for dates of service on or after April 1, anticipating forthcoming congressional action to address provider pay cuts.
CMS announced the temporary claims hold on Tuesday, saying it has briefed Medicare Administrative Contractors on the matter. The move comes after the Senate just recently passed a fix to address the 2% Medicare sequester reduction set to take effect with April’s arrival.
With senators making changes to the bill, the House must now take up the legislation again, but the lower chamber is currently on break. The American College of Radiology alerted its members about this “important matter” on Tuesday, noting that representatives are expected to pass the bill when they reconvene in mid-April. If CMS had not issued its directive this week, the doc payment cut would take effect after March 31.
Numerous provider groups including the Radiology Business Management Association, Centers for Diagnostic Imaging and Society of Nuclear Medicine and Molecular Imaging have urged Congress to address this issue. Lawmakers had previously paused this routine annual 2% reduction as part of a year-end spending bill, but radiologists and other physicians want to see the freeze extended through the rest of the public health crisis.
Absent any action, sequestration would result in $12.3 billion worth of reimbursement reductions for doctors, hospitals and nursing homes over the next nine months. CMS said that Medicare Administrative Contractors will automatically reprocess any claims paid with the reduction, if needed.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.