Supporting the Physiatrist, Strengthening the Specialty

As previously shared, Medicare physician payment rates under the Calendar Year (CY) 2024 Medicare Physician Fee Schedule (MPFS) are slated to be reduced by approximately 3.4% for 2024 relative to 2023. This will mark the fourth straight year of decreases to the payment rates under the MPFS.

While members of Congress have introduced several different pieces of legislation that attempt to mitigate the reductions to MPFS payment rates, it is not clear whether Congress will be successful in passing a payment fix, nor what the size of the fix will be if one is enacted. Furthermore, additional unknowns include when such legislation may be enacted, whether it will be retroactive to January 1, 2024 and how long it will take the Centers for Medicare and Medicaid Services (CMS) and its contractors to implement the fix– again, all assuming Congress is successful in mitigating the MPFS payment rate reduction.

Join the more than 330 Academy members who have already contacted their congressional representatives urging action to prevent the looming fee schedule cut. Take less than five minutes to submit your letter today!

As PM&R practices consider the current landscape and its potential implications for claims submission and payment, it may be helpful to consider the following information regarding Medicare claims processing timelines:

• Medicare claims are subject to “payment floor standards,” which establish a waiting period during which time the contractor may not issue payment on clean claims.
• For HIPAA-compliant electronic claims, payment may not be issued until day 14.
• For paper claims and non-HIPAA-compliant electronic claims, payment may not be issued until day 29.
• Medicare claims are also subject to “payment ceiling standards,” which specify the number of days by which a clean claim must be paid or denied. For both electronic and paper claims, claims must be paid or denied within 30 calendar days.
• Note that interest must generally be paid on clean claims if payment is not made within this time period, subject to some exceptions.

Additional information on these timelines can be found in Chapter 1 of the Medicare Claims Processing Manual, section 80.

Please contact Academy staff at healthpolicy@aapmr.org with any questions.

As previously shared, Medicare physician payment rates under the Calendar Year (CY) 2024 Medicare Physician Fee Schedule (MPFS) are slated to be reduced by approximately 3.4% for 2024 relative to 2023. This will mark the fourth straight year of decreases to the payment rates under the MPFS.

While members of Congress have introduced several different pieces of legislation that attempt to mitigate the reductions to MPFS payment rates, it is not clear whether Congress will be successful in passing a payment fix, nor what the size of the fix will be if one is enacted. Furthermore, additional unknowns include when such legislation may be enacted, whether it will be retroactive to January 1, 2024 and how long it will take the Centers for Medicare and Medicaid Services (CMS) and its contractors to implement the fix– again, all assuming Congress is successful in mitigating the MPFS payment rate reduction.

Join the more than 330 Academy members who have already contacted their congressional representatives urging action to prevent the looming fee schedule cut. Take less than five minutes to submit your letter today!

As PM&R practices consider the current landscape and its potential implications for claims submission and payment, it may be helpful to consider the following information regarding Medicare claims processing timelines:

• Medicare claims are subject to “payment floor standards,” which establish a waiting period during which time the contractor may not issue payment on clean claims.
• For HIPAA-compliant electronic claims, payment may not be issued until day 14.
• For paper claims and non-HIPAA-compliant electronic claims, payment may not be issued until day 29.
• Medicare claims are also subject to “payment ceiling standards,” which specify the number of days by which a clean claim must be paid or denied. For both electronic and paper claims, claims must be paid or denied within 30 calendar days.
• Note that interest must generally be paid on clean claims if payment is not made within this time period, subject to some exceptions.

Additional information on these timelines can be found in Chapter 1 of the Medicare Claims Processing Manual, section 80.

Please contact Academy staff at healthpolicy@aapmr.org with any questions.