American Society of Plastic Surgeons
For Consumers

Medicare claims processing on hold

Late on March 31, the Centers for Medicare & Medicaid Services (CMS) announced a temporary processing hold on all Medicare claims dated April 1 or later.

This announcement was made in anticipation of legislation that will extend the 2 percent Medicare sequester holiday.

Sequestration has been in place since 2013 to reduce Medicare program spending growth. Congress paused the Medicare sequester at the start of the pandemic to help support physicians facing major financial challenges due to the COVID-19 public health emergency; unfortunately, that moratorium expired today, April 1.

Recognizing the impact of an estimated $12.3 billion in Medicare reimbursement cuts over the next nine months, both houses of Congress had approved extensions of the 2 percent Medicare sequestration holiday. However, they did so through separate, distinct bills – meaning physicians will now have to wait until the House returns from its Easter and Passover recess on April 13 for a definitive solution. Until then, the cuts will be included in any Medicare claims processed.

CMS has a history of holding claims when Congress has been late in passing similar payment delays. For instance, in 2015, the agency paused payments to doctors to ensure that a double-digit cut didn't go into effect until Congress passed a fix. In its current notice, the Agency instructs Medicare Administrative Contractors (MACs) to withhold any claims unless they will affect physicians' cash flows; however, they have provided no information on the steps one might take to meet the cash flow exemption protocol.

How ASPS is supporting you

ASPS is working with the House to encourage swift passage of legislation and encourage CMS to be more transparent on how it determines "cash flow" issues when holding claims. Additionally, the Society will continue to work with Congress to ensure potential 4 percent Medicare cuts related to "pay-as-you-go" legislation passed over a decade ago are addressed before CY 2022.

If you have any questions, please do not hesitate to contact our Health and Payment Policy Department at (847) 981-5401.