With no movement from Congress
to avert 2% Medicare reimbursement cuts required by sequestration,
expect your Medicare revenue to drop for claims with dates of service
starting April 1.
Medicare providers will lose an
estimated $11 billion in revenue because of the cuts, CMS says.
Though Congress could enact a retroactive fix when it comes back
April 8 and 9, providers have no guarantee of that (PBN 2/28/13).
"Right now, it's looking difficult," says Robert
Tennant, senior policy advisor, Medical Group Management Association
(MGMA), Washington, D.C. (See a sequestration timeline, p. 8.)
Take note of how CMS will
calculate the cuts. The 2% cut won't be passed along to Medicare
beneficiaries' copays or deductibles, CMS announced in a recent
email. Instead, "the claims payment adjustment shall be applied
to all claims after determining coinsurance, any applicable
deductible and any applicable Medicare secondary payer adjustments,"
CMS stated.
As the American College of
Physicians (ACP) website explains: "The physician would continue
to collect from the Medicare beneficiary the usual 20% co-insurance
that otherwise would have applied before the 2% cut."
The ACP states, for example,
for a service for which Medicare allowed $100 before sequestration,
but $98 after sequestration, the physician would continue to collect
$20 from the beneficiary (20% of $100), not $19.60 (20% of $98).
This policy applies only to
assigned claims - that is, when the patient agrees to have Medicare
pay the physician directly.
For unassigned Part B claims,
Medicare payment to beneficiaries will be subject to the 2%
reduction, though they remain responsible to the provider for the
full limiting charge, according to Q&As on Medicare
administrative contractor (MAC) websites. Physicians should explain
to patients that the 2% reduction in the amount they receive from
Medicare is because of sequestration cuts.