Bulletin: December 23, 2009
Holding Medicare Claims Paid Under the 2010 Fee Schedule
NOTE: This information was updated in the 12/29/09 bulletin.
Because of possible legislative changes, CMS contractors will hold claims for the first 10 business days of January (January 1 through January 15) for 2010 dates of service that are paid under the Medicare Physician Fee Schedule (MPFS). After 10 business days, contractors will begin releasing held claims into processing under the fee schedule with the negative 21.2 percent update. If a new law is enacted that changes the negative update effective January 1, CMS will process claims under the new law and, if necessary, automatically reprocess most of those claims that were processed at the lower rate.
Providers may hold their claims until it becomes clearer as to whether new legislation will be enacted. Holding claims will reduce the need to reconcile two payments (initial claim and reprocessed claim), and it will simplify billing coinsurance and payment calculations for secondary payers. HARP clients who want to hold claims in HARP should contact their account representative to set this up.
Claims with dates of service on or before December 31, 2009, will be processed and paid under normal procedures.