President Bush Signs Legislation Reversing Medicare Physician Fee Cuts

Arlington, Va.- President Bush signed legislation yesterday that not only reverses the current 4.4 percent Medicare physician payment reduction, which went into effect on the first of year, but will also provide automatic reprocessing of claims retroactive to Jan. 1, 2006. The legislation was included in the Deficit Reduction Act. “The ACA is extremely pleased that Congress has halted the current cut in physician Medicare payments and that they have made the change retroactive,” said ACA President Dr. Richard G. Brassard. “The return to the 2005 rate is at least partial recognition by Congress that health care providers face significant challenges in today’s practice environment.” The Centers for Medicare & Medicaid Services (CMS) said it expects contractors to begin paying new claims using 2005 rates within two days of the legislation’s enactment. In addition, doctors of chiropractic will not need to resubmit existing claims submitted between Jan. 1 and Feb. 8, 2006. Contractors will automatically reprocess any claims that used the rates effective as of Jan. 1, 2006, and will instead use the zero percent update retroactive to Jan. 1. CMS estimates contractors should be able to reprocess all claims by July 1, 2006. Providers will receive retroactive payment for the differential in a lump sum. Physician fee schedule amounts are determined by regulation and the only way they can be changed is through legislation; this puts the issue in the hands of Congress. In late 2005, Congress evaluated the issue, but technical amendments in the Senate prevented final action on this critical issue until this week. CMS, recognizing that the physician payment adjustment could increase beneficiaries’ co-payments and deductibles for previously billed services, has suggested to the Department of Health and Human Services (HHS) that if a beneficiaries’ co-pay changed on Jan. 1, 2006, a physician waiver of the amount now owed by the beneficiary should not be considered inducement. More information will be available on the ACA Web site once a final decision has been made by HHS. “The ACA will continue to lobby on behalf of its members for fair reimbursement of Medicare services. It is imperative that Congress and HHS develop a permanent solution to the physician fee schedule because those most affected by this annual dilemma are not doctors, but patients,” said Dr. Brassard. Therapy Caps For most doctors of chiropractic – with the exception of those DCs participating in the Medicare Demonstration Project – coverage of chiropractic services is specifically limited to treatment by means of manual manipulation of the spine. However, the ACA has received numerous questions concerning therapy caps. With language included in Deficit Reduction Act, the President also authorized the Centers for Medicare and Medicaid Services (CMS) to develop a new exception process for Medicare beneficiaries to apply for medically necessary therapy services if their treatment is expected to exceed the $1,740 cap in 2006. The ACA will provide more information as it becomes available on its web site.

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