On February 1, 2006, the House of Representatives voted to approve the amended Budget Reconciliation Agreement. The President is expected to sign the agreement by tomorrow at the latest. The legislation includes a 1-year freeze in Medicare physician payment rates at the 2005 levels, which will halt the 4.4% reduction in 2006 Medicare physician payments that went into effect January 1, 2006. As we previously reported, the originally scheduled 4.4% reduction went into effect January 1, 2006, because the Senate modified the reconciliation agreement that was originally approved by the House of Representatives on December 19. The legislation had to go back to the House for reconsideration before it could be enacted. CMS is ready to implement provisions outlined in the legislation. Accordingly, CMS and its contractors will begin paying claims at the new rates within 2 days of the legislation’s enactment. In addition, because the legislation states that the freeze in physician payments at the 2005 levels is effective as of January 1, 2006,

CMS will automatically reprocess claims with dates of service between January 1, 2006, and the date of enactment. Providers will not need to resubmit claims already processed with the 4.4% reduction. Providers can expect to begin receiving aggregated payments for the difference between the new and previous rates over a period of approximately 5 months. The aggregated payments will include the usual remittance advice, or Explanation of Medicare Benefits (EOMB).

Furthermore, in light of the change in reimbursement, CMS will offer a second enrollment period for physicians to reconsider their participation status for 2006. The enrollment period will run for an additional 45 days. Should a provider decide to revise his or her participation election during the new enrollment period, the participation election will be retroactive to January 1, 2006.

ASCRS and ASOA members are encouraged to contact Nancey McCann, ASCRS Director of Government Relations nmccann@ascrs.org, or Emily Graham, ASCRS Manager of Regulatory Affairs, egraham@ascrs.org, in the Government Relations Department with any questions. You may also visit the ASCRS and ASOA web sites for additional information.