Optometrists again advised to hold Medicare claims

The AOA is again urging optometrists to hold Medicare claims until Congress acts to reverse a massive 21 percent Medicare fee cut that takes effect June 1. Legislation (H.R. 4213) to forestall the pay cut for 18 months was approved by the House of Representatives on May 28; however, the Senate is not scheduled to take up the bill until lawmakers return on June 7 after a Memorial Day recess. The announced 21 percent pay cut is required under Medicare's Sustainable Growth Rate fee-setting formula unless Congress acts to set Medicare fees. The bill approved by the House would provide a 2.2 percent update for the remaining months of 2010 and a 1 percent update for 2011 in lieu of the cut. The AOA Advocacy Group is actively lobbying to amend the fee-setting formula.

The Centers for Medicare & Medicaid Services (CMS) has already instructed Medicare payment contractors to temporarily hold fee-for-service claim processing for the first 10 business days of June, believing that Congress will continue working to avert the negative fee update. This hold will only affect claims with dates of service June 1, 2010 and later. The hold should have minimum impact on provider cash flow because, under the current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt, the CMS notes. The AOA will promptly provide updates to members on any action Congress takes regarding the Medicare Physician Fee Schedule.