The CMS said as soon as Congress passes the fiscal 2006 budget, expected in early February, it will tell Medicare contractors to reprocess claims filed since Jan. 1, when a 4.4% physician rate cut took effect, and retroactively freeze physician rates at 2005 levels. Physicians will receive a lump-sum payment in July reflecting the difference. The budget includes a one-year freeze on physician rates, averting the 4.4% cut, but Congress failed to pass the bill before the end of 2005. Medicare contractors handle some 20 million claims a week, and potentially 80 million claims may need to be reprocessed, the CMS said. As a result, the agency said, it will implement a phased-in reprocessing to be completed no later than July 1. The CMS also said it will give physicians another chance to sign up to accept Medicare patients for 2006, reopening the physician enrollment period for 45 days after the bill passes.
The CMS described its plans in a Jan. 6 letter to Sen. Chuck Grassley (R-Iowa) and Reps. Dan Burton (R-Ind.) and Bill Thomas (R-Calif.). The change may increase copayments and deductibles for beneficiaries under Medigap and secondary insurers. The CMS said it will instruct contractors to forward adjusted claims to insurers if their contracts allow. Otherwise, physicians may need to bill insurers separately to obtain the balance due. -- by Matthew DoBias