Providers are already bracing for the nine days of pain in late September -- but the situation may actually be worse than they expect.

Medicare plans to hold all claims from Sept. 22 through Sept. 30, as required by the Medicare Modernization Act. The Centers for Medicare & Medicaid Services had said that all of those claims would be paid promptly on Oct. 2. But now it turns out that may not be strictly true.

Some large carriers "may have a little difficulty mailing all of these held payments on a single day," a CMS official told the Aug. 11 physician open door forum. "Be patient with them," he pleaded. The carriers' mailrooms may have difficulty sending out that many checks on a single day.

"It might take up to about three days before those checks can get out, but they will all be dated Oct. 2 and ready to go," the CMS official added.

So it's even more important than ever for providers to prepare for what may turn into 12 lean days. To weather the storm, experts say providers should:

* Look at three factors. Whether an office takes special measures will depend on

how much Medicare money is in their mix, the anticipated percentage of cash flow drop and how much cash the office has in reserve, says Marvel Hammer with MJH Consulting in Denver.

* Estimate their shortfall. To get an estimate of how much money providers will have to go without during the suspension, Hammer recommends that providers select a similar nine-day window from the previous year and calculate how much Medicare money they got during that time period.

* Keep billing during the slowdown. Although the Medicare payment system is on hold during this period, providers' billing systems shouldn't be, stresses consultant Melinda Gaboury with Healthcare Provider Solutions in Nashville, TN. "Do not discontinue billing for any time period," she urges providers.

The payment hold "will also throw off billing timing, referrals to collections, notices to patients concerning outstanding bills, etc.," says Quinten Buechner, president of ProActive Consultants in Cumberland, WI.

Just how much the pay suspension will affect a physician's cash flow depends on the physician's specialty, says Marvel Hammer, owner of MJH Consulting in Denver. Specialties such as geriatrics, nephrology, primary care and general internal medicine will be the most affected by the suspension.