July 3, 2008
Questions and Answers Regarding the Holding of Claims Paid Under MPFS
The Questions and Answers below apply to the recent decision by the Centers for Medicare & Medicare Services to hold claims paid under the Medicare physician fee schedule (MPFS) up to 10 business days that contain July 2008 dates of service.| Q1. | Will claims containing services paid under the MPFS be held that contain
both June and July dates of service? |
| A1. | Yes, your local contractor will hold the entire claim for 10 business days. |
| Q2. | Will claims be held that contain both services paid under the MPFS and services paid under a separate fee schedule? |
| A2. | Yes, claims that contain both services paid and not paid under the MPFS will be held. For example, a claim with a July date containing an Evaluation and Management code and a drug code would be held. |
| Q3. | Does the holding of claims paid under the MPFS also include anesthesia
and purchased diagnostic services? |
| A3. | Yes, contractors will hold all claims with dates of service July 1, 2008, and after that contain services paid under the MPFS, including anesthesia and purchased diagnostic services. |
