Slight Delay in 2012 Medicare Claims Payment

CMS has just announced, due to Congress acting so late in 2011 to prevent the SGR cut, January 2012 claims must still be held to allow CMS time to develop and implement the new payment rate files and give the Medicare claims administration contractors time to install and test them.  As previously advised, Medicare claims administration contractors will be holding new, January 2012 claims for up to 10 business days.  We expect these claims to be released into processing no later than January 18, 2012.  Claims with dates of service prior to January 1, 2012, are unaffected. 
Minor Increase in 2012 Conversion Factor
The payroll tax extension legislation that was passed by Congress and signed by the President delayed the 27.4% Medicare pay cut due to the SGR formula for two months.  It also extended the floor on the work geographic practice cost index (GPCI) and certain other policies.  However, CMS has confirmed that all of the other changes that were included in the Medicare physician payment final rule for 2012 will still take effect.  While the physician fee schedule update will be zero percent, other changes to the relative value units used to calculate the fee schedule rates must be budget neutral.  To make those changes budget neutral, the conversion factor must be adjusted for 2012.  CMS is currently developing the 2012 Medicare Physician Fee Schedule (MPFS) to implement the zero percent update.  The 2011 conversion factor was $33.9764.  The 2012 conversion factor will be $34.0376.  CMS published in the Jan. 4, 2012, Federal Register a correction notice to the 2012 final rule that modifies the relative values for a number of services.  The agency also posted to its web site a revised relative value file reflecting both the corrections and the legislation that stopped the 27.4% cut.  Medicare contractors will be posting the new rates on their websites no later than January 11, 2012.