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Medicare Holds Claims Pending Congressional Action

Medicare reimbursement rates already are low enough for fire departments and are set to decline even further. While Congress is working to pass legislation to avert the implementation of a 2% reduction to all Medicare reimbursements, this delay will not be enacted before the cuts take effect on April 1. As a result, the Centers for Medicare and Medicaid Services (CMS) will hold claims submitted after April 1 in anticipation of Congressional action to delay these cuts. Securing a delay for these cuts is extremely important as it could save the nation’s fire and emergency service millions of dollars in lost reimbursements. 

In 2011, the nation teetered atop the “fiscal cliff.” A combination of expiring tax cuts and increased debts and deficits forced Congress to take drastic action. The last-minute swerve that averted the cliff was known as the Budget Control Act of 2011 (P.L. 112-25). This legislation established mandatory spending cuts in both defense and non-defense spending in order to reign in federal expenditures.

Congress has generally prevented these cuts, also known as sequestration, from taking effect. These delays in the sequestration cuts have come in varying time intervals, but usually forestalled these cuts from actually reducing spending. Currently, Medicare suppliers and providers, including all Medicare-enrolled ground ambulance agencies, could face an across-the-board 2% reduction in Medicare reimbursements. In an effort to protect fire department reimbursements, the IAFC worked with other national fire and EMS organizations to support legislation to delay the implementation of these cuts until the end of the year. While the House and Senate both passed bills to delay these cuts until January 1, the two chambers failed to reach an agreement on exact language. 

CMS recognized the fact that Congress cannot delay the cuts in time and announced that it will hold all claims submitted after April 1. These actions by CMS have happened other times in the past and are designed to prevent the need for CMS to re-process and retroactively reimburse agencies once Congress passes legislation to delay the cuts. Congress is expected to pass their delay of these cuts when they return to session on the week of April 12. CMS anticipates processing all held claims once Congress formally delays the implementation of the 2% rate cut.  

The IAFC urges Congress to act as quickly as possible to delay this 2% reduction in payment and prevent Medicare reimbursement rates from falling even further. Ultimately however, a permanent solution is needed to ensure Medicare’s reimbursement rates are not reduced in the future. Congress must develop policies that ensure fire departments always will be completely reimbursed for the expenses associated with providing emergency medical care.  

Evan Davis is  strategic government relations manager for the IAFC

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