In the usual right up to the wire, last minute fashion common amongst government entities, Medicare (CMS) issued the following statement regarding the proposed Medicare fee cuts that were supposed  to go into effect Monday, March 1, 2010:

“CMS is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other providers of services paid under the Medicare physician fee schedule (MPFS).  The Department of Defense Appropriations Act of 2010 provided a zero percent (0%) update to the 2010 MPFS effective for dates of service January 1, 2010, through February 28, 2010.

We believe Congress is working to avoid the negative update that will take effect March 1, 2010.  Consequently, CMS has instructed its contractors to hold claims containing services paid under the MPFS for the first 10 business days of March. The holding of MPFS claims will only affect claims with dates of service March 1, 2010, and forward.  This hold should have a minimum impact on provider cash flow because, under current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt.”

In other words, Medicare still doesn’t know whether or not there will be a fee cut.  And in the meantime, they will hold your claims and do nothing.  But, no worries, by law they have 14 calendar days (for electronic) and 29 calendar days (for paper billing) to get their act together and decide what you will be paid.

Presumably, you have nothing better to do than check the Medicare website (or that of your carrier) for the moment when the decision is finalized.

For an organization willing to slap a fine on you for “inducements” of any gift in excess of $10, they are not worried in the slightest on how their financial sloppiness affects our patients.  Sure, Medicare claims their indecisiveness “should have a minimal impact on cash flow” because they have the grandest of intentions of still paying you on time. (The failure of which will likely be the subject of a future statement released by CMS.)    However, notice the conspicuous lack of advice on matters of over-the-counter fee collection whilst we all wait in limbo.

Should we collect based on the 2009 fees, the anticipated fee cut, the negotiated slightly reduced compromise fee cut or anything in between?

In reality, for chiropractors the fee cuts – however large or small – may have a relatively minimal impact on our bottom line, especially when compared to other specialties.  After all, even a 20% reduction on a $35 is $7.   Not pleasant, but not likely to break the bank.

What will add insult to injury is the calculation of the difference between what you are collecting now and what you should have been collecting on March 1 and the time differential that Medicare notifies you about what should have been done, had they informed you on time, along with the positive or negative financial accounting and remuneration that goes along with it.

If you can read and comprehend that sentence (and I am not sure I can, even though I wrote it!) you will likely have no problem with the upcoming changes.  Perhaps you should even go to work for CMS as a translator or policy writer.

For the rest of us, here’s the skinny in plain English and my recommendations:

• For now, there is no Medicare fee cut (nor any fee raise)

• Continue operations under your 2009 local carrier fee schedule
• Collect any co-pays or patient portions with no changes
• That way WHEN Medicare does release their fee schedule, you can accurately calculate whether you owe the patient or they owe you more.
• Get ready to support your state and national associations to oppose drastic fee cuts
• Write to your Senator to oppose the fee cuts and tell them what a ridiculous inconvenience these shenanigans are for you and your patients (their constituents)

(Please note, these are my recommendations, not requirements, as there are no new requirements yet!)

If this frustrates you, hey at least you know you are alive.  It is my understanding that the dead do not experience such emotions.  On the bright side, US Citizens are not the only ones subject to the frustrations of their ruling class.  Other countries do, however, formulate protests with a bit of humor which makes the bad news go down easier.  For example:

• In response to frustrations with city council, the 1959 election in Sao Paulo Brazil featured Cacareco, a five-year-old female rhinoceros, who ran under the platform “better to elect a rhino than an ass.”  She won by a landslide.
• In 1967, in anticipation of municipal elections throughout Ecuador, the Pulvapies foot powder company launched an advertising campaign that featured the slogan: “Vote for any candidate, but if you want hygiene, vote for Pulvapies.”  Apparently the hygiene of the area had slipped so badly under the current regime that Puvapies won the election, under protest from actual human candidates.
• The all-time winner of electoral protest goes to Guinness book of World Record holder, Lord Sutch whose platform was “Vote for insanity — you know it makes sense.” He campaigned in a top hat and leopard-skin tail coat. His proposals included bringing back the village idiot, putting joggers on treadmills to make them generate electricity, breeding fish in wine so they could be harvested ready-pickled, converting coal mines into bungee-jumping centers (and making local politicians be the first to test them), and making all dogs eat phosphorescent food so that their poop could be seen at night.

Stay tuned for more details and in the meantime, keep your nose to the grindstone because Medicare may be paying you less money for more work very soon, (maybe).  Your other option is to follow the advice of the “bang head here” group and hope this resolves quickly, though I am not sure I recommend that route.

Keeping you informed (like it or not!),

Tom Necela, DC

P.S.  For those of you who wish to Work Smarter, Not Harder in spite of the wave of regulations, rules and changes Medicare and any other third party payer throws at you, I have two upcoming seminars in Seattle and Portland on Chiropractic, Billing, Coding, and Documentation Mastery (click link for more details an registration)

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