Find-A-Code Focus Newsletter

Let the Medicare Fee Schedule Games Begin!

December 20, 2011

Once again, partisan bickering is adversely affecting providers who bill Medicare. This same problem has been going on for years. Last year legislated pay cuts were averted through a one year "hold". Before that, the roller-coaster payment ride went on and on. For several months now, we've been hearing about the legislated 27% pay cut that is scheduled to take effect on January 1st. Provider groups and professional associations have been trying to persuade congressional leaders to stop the madness (see

The House of Representatives passed legislation (HR 3630) to prevent this cut along with extending other benefits for the remainder of 2012. Then on Saturday, the Senate passed their own version of the bill which only extended a payment fix for 2 months (until February 29, 2012) and added on a provision for an oil pipeline of all things. Needless to say, the House is not happy about the changes and today called for a special meeting to address the issue. Of course, Obama is now in the hot seat. In this all important election year, if he signs the bill, it will anger environmentalists. If he vetoes it, then it will anger healthcare workers and blue collar workers who desperately need the construction jobs the oil provision will yeild. Whose votes will be sacrificed?

The American Medical Association and the Medical Group Management Association have both issued statements about the insanity of this situation. This ongoing fee schedule issue is having a negative effect on the availability of providers as more providers opt out of Medicare simply because it is not worth the hassles.

It is reprehensible that our congressional leaders would hold physicians hostage in this manner. This type of political manuevering has allowed the problem to continue to escalate from year to year. We strongly encourage providers to contact their congressional leaders and encourage them to make the best of a bad situation for right now and pass HR 3630. Also, a permanent fix for 2012 and beyond needs to happen by repealing the law that created the problem in the first place.

FOR NOW... a recent CMS announcement stated that contractors need to hold claims for 2012 dates of service for the first 10 days of January because of this pending legislation. Just hold on to your 2012 claims while the dust settles a little on this issue. It would also be wise to catch up on your outstanding claims before the January 2012 commotion begins.

For more information about the current legislation, see



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