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ECP Update: April 2013

 

 

 

The following update from ECP is in keeping with our intention to be your source of timely industry news and updates to help keep you informed on matters that pertain to the healthcare industry, available services and ECP. 

 

Part B News Update:

2% payment cuts start for Medicare claims with dates of service on or after April 1, 2013

 

  

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.

 

  

Please contact ECP for 

questions or more information 

 800-327-1213

 

 

 

About ECP

ECP is a medical claims clearing house for 10,000+ providers nationwide. Since 1990, ECP has helped providers to reduce costs, increase productivity, and speed up the collection of receivables from payers and patients. ECP provides outstanding, results oriented customer service to our clients; helping them to manage the billing cycle. ECP is committed to maximizing the production and cash flow of our clients through proven industry experience, established processing methods, seasoned personnel, and cutting edge technology.

 

For more information, please visit www.4ECP.com

 

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