Medicare Improvements for Patients and Providers

The Medicare Improvements for Patients and Providers Act of 2008 enacted July 15, 2008 created changes to the Medicare program. These changes have been communicated to affected parties (such as - physicians, therapy services, DMEs).

As a result of the new law, the mid-year 2008 Medicare Physician Fee Schedule (MPFS) rate reduction of -10.6% is retrospectively replaced with the fee schedule rates in effect from Jan - June 2008, which reflected a 0.5 percent update from 2007 rates. Additionally, MPFS payment rates are being revised to increase the fee schedule amounts for certain mental health services. More information on physician pay issues is available at Centers for Medicare & Medicaid Services (CMS).

Under the Medicare statute, Medicare pays the lower of submitted charges or the Medicare fee schedule amount. Claims with dates of service July 1 and later billed with a submitted charge at least at the level of the January 1- June 30, 2008, fee schedule amount will be automatically reprocessed. Any lesser amount will require providers to contact their local contractor for direction on obtaining adjustments. Non-participating physicians who submitted unassigned claims at the reduced nonparticipation amount also will need to request an adjustment.

CMS will be implementing other provision of the legislation in the coming months and will announce additional information as it becomes available.