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Medicare Payments On Hold Pending Congressional Sequester Fix

On Behalf of | Apr 28, 2021 | Publications

By Mathew J. Levy, Esq. & Zoila Sanchez, J.D., M.P.H. Email Mathew Email Zoila

Participating Medicare providers already experiencing financial hardship due to the pandemic would be further hit by a 2% payment cut until Congress takes action next month with the passage of a sequester fix. To address this issue, the Centers for Medicare & Medicaid Services (“CMS”) is temporarily pausing Medicare payments to providers.

CMS recently announced “Temporary Claims Hold Pending Congressional Action to Extend 2% Sequester Reduction Suspension” in a special news edition of its MLN Connects newsletter, available here. CMS’ notification instructs Medicare Administrative Contractors (“MACs”) to temporarily pause all claims with dates of service on or after April 1, 2021, for a short period, without affecting providers’ cash flow.

Additionally, the change is intended to minimize the number of claims that MACs must reprocess if Congress were to extend the suspension. Further, CMS assures that if necessary, the MACs will automatically adjust. Additionally, the MACs will reprocess any claims that were paid with the reduction applied.

If you are a participating Medicare provider, you can find your MAC Provider Contact Center at this website.

Importantly, if you are a provider seeking clarification on how these changes may affect you, you can contact Mathew J. Levy at 516-627-7000 or [email protected].

Mathew J. Levy is a Shareholder/Director of Weiss Zarett and co-chairs the Firm’s corporate transaction and healthcare regulatory practice. Mr. Levy has extensive experience in defending healthcare professionals in actions brought by state licensing authorities and federal agencies. Mr. Levy has successfully defended numerous healthcare providers in actions involving the US Attorney’s Office investigations, Medicare Fraud Waste and Abuse investigations, Medicaid Fraud Control Unit investigations, OPMC, OPD, Medicare, Medicaid as well as commercial insurance audits. Mr. Levy has successfully structured and negotiated joint-venture agreements, private equity transactions, venture capital transactions, stock purchase agreements, asset sale agreements, shareholders agreements, partnership agreements, employment contracts, managed care agreements, and commercial leases.

Zoila Sanchez, J.D., M.P.H. joined Weiss Zarett full-time upon graduating with her Juris Doctor degree from the Maurice A. Deane School of Law at Hofstra University. During law school, Ms. Sanchez served as a Legal Clerk with the U.S. Department of Health and Human Services Office of Counsel to the Inspector General in Washington, DC, where her work focused on health care fraud and abuse. Ms. Sanchez has experience in supporting Weiss Zarett’s business and health care law and litigation practice areas.

Weiss Zarett Brofman Sonnenklar & Levy, P.C. is a Long Island law firm providing a wide array of legal services to the members of the health care industry, including corporate and transactional matters, civil and administrative litigation, healthcare regulatory issues, bankruptcy and creditors’ rights, and commercial real estate transactions.