SGR Update and Medicare Claims Holds - New Jersey MGMA

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SGR Update and Medicare Claims Holds

Date: December 20, 2012

CMS Releases Notice on Claims Holds

Without Congressional action to avert a reduction, Medicare payments to physicians will be cut by 26.5%, beginning January 1, 2013. Accordingly, the Centers for Medicare and Medicaid Services (CMS) released a statement this afternoon announcing that it is in the process of sending notification to healthcare providers that it will hold CY 2013 electronic claims for 10 business days until January 11, 2013. At that time, they will evaluate what further action needs to be taken in light of any pending Congressional action on the Sustainable Growth Rate (SGR). Under the current law, CMS must pay clean electronic claims within 14 days of receipt and within 29 days for paper claims.

Claims for services rendered on or before December 31, 2012, are unaffected by the 2013 payment cut and will be processed and paid under normal procedures and time frames.