It appears that some Medicare contractors are having more difficulty than others adjusting their computer systems to reflect the SGR "fix" and related issues.   

According to CMS, the lengthy delay in getting Congressional approval for rescinding the SGR cut; the retroactive application of the restoration of higher payments and the inclusion of a 2.2% increase in payments on those claims presented particular administrative and technological challenges for Medicare's contractors. 

CMS stated it took some coordination to release claims from the claims hold that CMS initiated as Congress worked to pass legislation that allowed for a positive reimbursement level.

CMS contractors were directed to begin releasing claims in late June, at the same time that they were simultaneously adjusting claims that were paid at the lower (SGR cut) rate.  The Medicare contractors should have completed the adjustment processing nationally on July 9 and all of the claims that had been held, pending fee schedule update, should have been released for processing the week of July 19th thru July 23rd.

CMS acknowledges that some Contractors did a better job of handling this situation than others and as a result, there was some variation across the country in terms of processing. There were also some delays nationally because of limits on the processing capacity at CMS's data centers.  The holding of millions of claims strained the computer capacity of several contractors and this also contributed to the problems.

CMS believes that things should smooth out shortly.