RE: First Coast and MCR fee schedule

[Guest guest]

- Below is an email that I received from Florida Medicare (First Coast

Service Options) regarding processing of claims. This should answer your

questions:

New 2008 Medicare Physician Fee Schedule Payment Rates Effective for Dates

of Service July 1, 2008 through December 30, 2008

The Medicare Improvements for Patients and Providers Act of 2008 was enacted

on

July 15, 2008. As a result, the mid-year 2008 Medicare Physician Fee

Schedule (MPFS) rate of -10.6 percent has been replaced with a 0.5 percent

update, retroactive to July 1, 2008.

Physicians, non-physician practitioners and other providers of services paid

under the MPFS should begin to receive payment at the 0.5 % update rates in

approximately 10 business days, or less. Medicare contractors are currently

working to update their payment system with the new rates.

In the meantime, to avoid a disruption to the payment of claims for

physicians, non-physician practitioners and other providers of services paid

under the MPFS, Medicare contractors will continue to process the claims

that have been on hold on a rolling basis (first in/first out) for payment

at the -10.6% update level. After your local contractor begins to pay

claims at the new 0.5% rate, to the extent possible, the contractor will

begin to automatically reprocess any claims paid at the lower rates.

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.

Contractor websites are being updated with the new rates and these should be

available shortly.

Be aware that any published MLN Matters articles affected by the new law

will be revised or recinded as appropriate.

Finally, be on the alert for more information about other legislative

provisions which may affect you.

Further instructions regarding other provisions of MIPPA will be

forthcoming.

Beckley, MS, MBA, CHC

Certified Healthcare Compliance

www.BloomingdaleConsulting.com

_____

From: PTManager [mailto:PTManager ] On Behalf

Of windyskate

Sent: Wednesday, July 30, 2008 9:52 AM

To: PTManager

Subject: First Coast and MCR fee schedule

Hello fellow Florida and Connecticut PTs:

Has anyone held back on sending in MCR claims waiting for First Coast

to get up to speed with the new fee schedule? Or have you been sending

in your claims and how has that been going?

My billing company has recommended to hold off sending the claims due

to the delay however it is almost a month now. I believe the billing

company's concern is the extra work they will have to do if the

schedule is not up to date.

Any comments/thoughts would be greatly appreciated.

Yunker, PT

American Health and Rehabilitation

Fort Lauderdale, FL