MPFS claims may be held through Jan. 15 as CMS tests new payment system


The American Taxpayer Relief Act of 2012 became law on Jan. 2 when President Barack Obama signed the legislation. Among its many provisions, the law substitutes a zero percent update in place of a 26.5 percent payment cut for physicians and other practitioners who treat Medicare patients between Jan. 1 and Dec. 31, 2013. Now it's up to the Centers for Medicare & Medicaid Services (CMS) to test and implement the system that processes physician payments.

In a statement issued Jan. 3, CMS said it is currently revising the 2013 Medicare Physician Fee Schedule (MPFS) "to reflect the new law's requirements as well as technical corrections identified since publication of the final rule in November [2012]."

CMS reported that the 2013 MPFS conversion factor is $34.0230.

The agency noted that Medicare claims administration contractors may hold MPFS claims with January 2013 dates of service for up to 10 business days (through Jan. 15) as the new system is being tested and deployed. CMS said it expects any held claims to be released into processing no later than Jan. 16.

"The claim hold should have minimal impact on physician/ practitioner cash flow because, under current law, clean electronic claims are not paid sooner than 14 calendar days (29  for paper claims) after the date of receipt," the CMS statement said.

Claims with dates of service prior to Jan. 1, 2013 are unaffected, according to CMS.

The agency added that Medicare claims administration contractors will be posting MPFS payment rates on their websites no later than Jan. 23.

CMS also noted that its 2013 Annual Participation Enrollment Program gave eligible providers, practitioners and suppliers a chance to change their participation status through Dec. 31, 2012. Given the new legislation, CMS has extended the participation enrollment period through Feb. 15, 2013. (Participation elections and withdrawals must be postmarked on or before Feb. 15.) The effective date for any participation status changes elected by providers during the extension remains Jan. 1, 2013, CMS said.