Even non-Medicare reimbursement was affected for many providers whose participation agreements with plans contained fee schedules based off of Medicare reimbursement. While this suspension of sequestration is certainly good news for providers participating in traditional fee-for-service Medicare, and plans offering Medicare Advantage products, the effect the suspension will have on reimbursement for providers participating in Medicare Advantage or commercial lines of business which rely on Medicare rates is slightly less clear.
For providers participating in agreements that have provisions that explicitly address the effect of legislative changes to payments such as sequestration, such agreements should be reviewed.
In more recent agreements that do not directly address the issue, it may be more difficult to ascertain the effect sequestration has had on reimbursement under the agreement — and, therefore, the effect of this suspension.
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