HOLD ON MEDICARE PAYMENTS

Be aware that Medicare will put a hold on Medicare payments for ALL claims (e.g., initial claims, adjustment claims, and Medicare Secondary Payer (MSP) claims) for the last nine days of the Federal fiscal year, i.e., Sept. 22-30, 2006. Providers need to be aware of these payment delays, which are mandated by section 5203 of the Deficit Reduction Act (DRA) of 2006. Accelerated payments using normal procedures will be considered. No interest will be accrued or paid, and no late penalty will be paid to an entity or individual for any delay in a payment by reason of this one-time hold on payments. All claims held as a result of this one-time policy that would have otherwise been paid on one of these nine days will be paid on Oct. 2, 2006. This policy applies only to claims subject to payment. It does not apply to full denials and no-pay claims. It also does not apply to periodic interim payments, home health request for anticipated payments, cost reports settlements, and other non-claim payments. Additionally, Medicare contractors will continue to apply the 14-day electronic claim payment floor and the 29-day paper claim payment floor. On a case-by-case basis, Medicare FIs, RHHIs or carriers may make adjustments, after Oct. 1, 2006, for extenuating circumstances raised by a provider. Payments will not be staggered, and no advance payments during the nine-day hold will be allowed. CR5047 is the official instruction issued to your carrier regarding changes mentioned in this article. CR5047 may be found by going to the CMS Web site (click here). Please refer to your local carrier if you have questions about this issue.