Monday, July 21, 2008

More on the Medicare Fix Act, H.R. 6331

The House Ways and Means Committee has posted a series of fact sheets about H.R. 6331. I read in BNA this morning that the new law also postpones until September 30, 2009, Medicaid's adoption of the average manufacturer price reimbursement methodology for generic drugs dispensed by retail pharmacies. This was a reform mandated by the Deficit Reduction Act of 2005. Pharmacies argued that the change would bankrupt them.

CMS posted a fact sheet explaining how it will implement the new law. The fact sheet explains that

Physician Pay

As a result of the new law, the mid-year 2008 Medicare Physician Fee Schedule (MPFS) rate reduction of -10.6 percent is retroactively replaced with the fee schedule rates in effect from January – June, 2008, which reflected a 0.5 percent update from 2007 rates. In addition, MPFS payment rates are being revised to increase the fee schedule amounts for certain mental health services. Effective immediately, CMS has instructed its contractors to implement the new law. However, it may take up to 10 business days to implement these changes. To minimize physician disruption during this transition, CMS will post the new physician fee schedule as soon as possible and will continue its rolling 10 day hold and release of claims. This means that, until the new fee schedule rates are implemented, some claims may still be paid at the lower rates that were in effect between July 1st and July 15th. To the extent possible, contractors will begin to automatically reprocess any claims paid at the lower rates in a timely manner. CMS will issue guidance about the collection of corrected co-insurance payments in the next few days.

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