According to Terri Fischer, health care manager with LarsonAllen, the thought behind putting these claims on hold is there will be less disruption to a physician’s practice should Congress enact a new law, retroactive to July 1, changing the negative impact on the fee schedule. Under the CMS instructions, practices would not have to process two potential payments and adjustments for the same claim—the initial claim payment and the reprocessed claim payment.

After 10 business days, the contractors will release the claims to be paid based on the applicable current law (fee schedule). CMS has suggested in its news releases that providers hold their current claims in-house as long as possible. However, there may be claim backlogs that cause delays in payments once the issue is fixed.

Continue sending in your claims
Fischer recommends that physician practices continue to send in their claims right away. “If you continue to submit them to carriers as usual, the impact on your practice should be minimal,” she says.

The 10-day claims hold is expected to have minimal impact because under the current law, Medicare claims cannot be paid sooner than 14 days if the claim is in Medicare’s hands. If your practice waits 10 days to submit a claim, you will have to wait an additional 14 days since Medicare's payment floor does not start until they receive the claim.

The week of July 7 is the earliest Congress can consider legislation to stop the deep reimbursement cuts and the 10-day delay will buy Congress that time.

We advise practices to pay close attention to the congressional activity relating to Part B reimbursement and to be diligent in reading the releases from their Part B carriers.