Interest Area: Medicare
Priority: Moderate
The notice below, from Empire Medicare Services, provides official notification of the adjustments to be made on claims that were paid under the 2006 fee schedule that was in effect prior to passage of the Deficit Reduction Act (DRA) of 2005. It also explains that the enrollment period for 2006 has been revised as a result of the change in the MPFS.
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Medlearn Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Provider Types Affected
Physicians, suppliers, and providers billing Medicare contractors (carriers, regional home health intermediaries (RHHIs), and/or fiscal intermediaries (FIs)) for services paid under the MPFS provided to Medicare beneficiaries
Important Points to Remember
- This article is based on Change Request (CR) 4313, which states that Congress has amended the physician update from a negative 4.4-percent (- 4.4%) update to a zero-percent (0%) update for services provided on or after January 1, 2006, and paid under the MPFS.
- Within two days of the enactment of the new legislation, Medicare contractors (i.e., carriers, FIs, and RHHIs) will begin to automatically reprocess those claims paid at the -4.4 percent update.
- New MPFS fees will be posted on the carrier sites as soon as possible after the bill is signed by the President. Your carrier may charge a reasonable fee for mailing a hardcopy version of the MPFS if you choose not to access the MPFS via the Internet.
- The Centers for Medicare & Medicaid Services (CMS) will create another participation enrollment period that will begin after the President signs the bill, and the enrollment period will run for 45 days.
Background
Congress has passed the Deficit Reduction Act (DRA) of 2005, which, among other things, changes the update to the 2006 conversion factor for services paid under the Medicare Physician Fee Schedule (MPFS). The DRA replaces the previously announced -4.4-percent reduction with a zero-percent increase for services paid under the MPFS. The change is effective retroactive for service on or after January 1, 2006.
Because of the change in the 2006 MPFS rates, CMS will create another participation enrollment period that will run for 45 days. More specific information concerning a second participation enrollment period will be appear in a forthcoming change request (CR) and related Medlearn Matters article.
This CR only addresses the change in payment rates related to the new zero-percent update to the conversion factor and reprocessing of claims that were paid using the -4.4-percent update rates.
Claims processed with the -4.4-percent rates will be reprocessed with the new rates and adjustments will be made. Medicare contractors will complete the necessary adjustments no later than July 1, 2006. In the event your claims are not adjusted by your carrier/FI/RHHI, contact them to bring the issue to their attention, and they will make the adjustments.
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Note: Services not paid under the MPFS, i.e., DME, Lab, ambulance etc., are not affected by CR4313.
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Implementation
Medicare carriers and intermediaries will have two business days from the date of enactment of the Deficit Reduction Act to begin to process claims using the new fees as well as to begin reprocessing claims using those new fees.
Additional Information
The official instructions issued to your Intermediary or Carrier regarding this change can be found at http://www.cms.hhs.gov/Transmittals/downloads/R207OTN.pdf 
on the CMS Web site.
If you have questions, please contact your Medicare carrier/FI/RHHI at their toll-free number which may be found at http://www.cms.hhs.gov/MedlearnProducts/downloads/CallCenterTollNumDirectory.pdf on the CMS Web site.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.
For more information, visit the Medlearn Matters Web page at: http://www.cms.hhs.gov/MedlearnMattersArticles 
Pub. 100-4, Transmittal# R207OTN, CR# 4313
Medlearn Matters Number: MM4313
Related CR Release Date: February, 1, 2006
Effective Date: January 1, 2006
Implementation Date: See “Implementation” section of article.
Posted: 02/24/2006
CPT codes, descriptions, and other data only are copyright 2005 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Apply.
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