Well, it looks like groups will start having claims processed at the 21% reduction rates until this is fixed - with the fix (if it comes) handled by re-processing claims.

The Centers for Medicare and Medicaid Services (CMS) just released an official announcement regarding the processing of claims in light of Congress’ failure to extend the freeze on Medicare physician payments. Please find the full text of the announcement below.

The Senate continues to debate an amended version of H.R. 4851, the Continuing Extension Act of 2010, legislation which would continue the payment freeze at its current level through May 31. Once the Senate completes action on this bill, it will return it to the House for their consideration. Since this version of the extension legislation is different than the version passed by the House on March 17, the House must approve this Senate-passed version before sending it to the president for his signature. Yesterday, the House Rules Committee approved a rule allowing for swift consideration of this amended version of H.R. 4851. The House is expected to act on this legislation this week.

CMS Statement on processing of claims:

CMS continues to work with Congress towards possible legislative action to extend the zero percent update for the Medicare Physician Fee Schedule.  The zero percent update expired on March 31, 2010.

We are hopeful that Congress will take action in the next few days.

Until now, CMS has been holding April 2010 date-of-service claims, anticipating congressional action.  But that has not occurred.

Therefore, under current law, Medicare contractors will begin processing claims with dates of service April 1 and later at the negative update rates.  This will begin as soon as systems are fully tested to ensure proper claims payment.  And, Medicare contractors will pay these claims on a first in - first out basis.

If subsequent congressional action extends the zero percent update retroactive to April 1, 2010, Medicare will reprocess those claims at the higher rates.  Claims with submitted charges at or above the higher rates will be able to be automatically reprocessed without further action.

Providers have the option of holding their affected claims until the legislative landscape becomes clearer.

Claims with dates of service prior to April 1, 2010, are not affected and will continue to be processed under normal procedures at the rates in effect on the date of service.