There are two business days left to CMS' two-week claims processing delay--enacted to bridge a gap between Congress' first missed deadline for overturning Medicare physicians' 21 percent pay cut and its eventual passed legislation--and it appears even that won't be enough time to protect practices' cash flows.

Sen. Charles Schumer (D-N.Y.) said at a press conference that the Senate is expected to have 60 votes to pass the bill "early next week," but it may still take several days to be passed by the House and signed into law. Because CMS cannot legally delay claims processing any longer, after Tuesday, physicians will have two unenviable choices for how to handle their Medicare claims.

Option 1: Physicians can hold onto their claims until their pay rate is fixed, and be reimbursed the correct amount the first time. The drawback, especially for smaller practices, is the difficulty in meeting payroll and other overhead expenses with zero Medicare reimbursement entering their bank accounts. On average, Medicare represents roughly 30 percent of physicians' revenue, according to the Center for Studying Health System Change.

Option 2: Submit claims right away and get reimbursed one-fifth less, leaving Medicare to settle up the difference retroactively once a bill is passed.

Either way, the pay cut complicates the task of collecting Medicare copays, which equal 20 percent of the allowable Medicare fee. So if fees decrease, so do copays. In the past, physicians have been allowed to collect the unreduced copays during periods of pay-cut limbo, Cynthia Hughes, a coding specialist at the American Academy of Family Physicians, told Medscape Medical News. If they choose to charge lower amounts, CMS may, as it has done before, instruct physicians to forgo collecting amounts smaller than the cost of billing for them, which is typically around $5, she says.

To learn more:
- read this article on The Hill
- check out this Medscape Today piece

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