Update: June 25, 2010
The U.S. House approved a Senate-passed bill Thursday night (6/24), in effect delaying a 21.3-percent Medicare physician payment cut for six months and raising the payment rate by 2.2 percent through November 30. President Obama signed the bill Friday morning.
The measure carries a $6.4 billion price tag and still the payment formula has not been eliminated or replaced. When this new six-month delay ends, the mandated SGR cut is expected to be higher than 21 percent.
CMS Processing
The bill is retroactive to June 1, when the reimbursement cuts were originally scheduled to happen. The Centers for Medicare & Medicaid Services (CMS) has directed Medicare claims administration contractors to discontinue processing claims at the negative update rates and to temporarily hold all claims for services rendered June 1, 2010, and later, until the new 2.2-percent update rates are tested and loaded into the Medicare contractors’ claims processing systems. Effective testing of the new 2.2-percent update will ensure that claims are correctly paid at the new rates. CMS officials expect to begin processing claims at the new rates no later than July 1, 2010. Claims for services rendered prior to June 1, 2010, will continue to be processed and paid as usual.
Claims containing June 2010 dates of service which have been paid at the negative update rates will be reprocessed as soon as possible. Under current law, Medicare payments to physicians and other providers paid under the MPFS are based on the lesser of the submitted charge on the claim or the MPFS amount. Claims containing June dates of service that were submitted with charges greater than or equal to the new 2.2-percent update rates will be automatically reprocessed. Affected physicians/providers who submitted claims containing June dates of service with charges less than the 2.2 percent update amount will need to contact their local Medicare contractor to request an adjustment. Submitted charges on claims cannot be altered without a request from the physician/provider. Physicians/providers should not resubmit claims already submitted to their Medicare contractor.
Update: June 23, 2010
Medicare payment cuts have taken effect and claims are being processed at the 21.3-percent lower rate, even as the AMA says Congress is expected to resolve the issue by the end of the week.
However, another temporary "patch" that will delay the cuts for six months and give doctors a 2.2-percent payment update is being held up in a fight between the Senate and House over a jobs bill. The Senate broke out the Medicare fix and passed it on Friday but the House version is still part of a larger measure to expand jobless benefits. House Speaker Nancy Pelosi (D-CA) is holding firm on the House version of the bill and sees "no reason" to pass the Senate bill.
Please continue to watch the TMA's Twitter and Facebook sites for the latest updates on the Medicare/SGR situation.
Update: June 18, 2010
On Friday afternoon, the Senate passed an amended version of H.R. 3962, now called the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010,” by unanimous consent. This legislation provides a 2.2-percent Medicare physician payment update for six months, from June 1 through November 30, 2010, in lieu of the scheduled 21.2 percent cut.
Unfortunately, the House of Representatives is not scheduled to hold any floor votes until next Tuesday evening. As a result, the Centers for Medicare and Medicaid Services (CMS) is instructed its carriers today (June 18) to lift the hold on processing claims for services provided on or after June 1, and to begin processing them under the law’s negative update requirement. In other words, claims will start to be paid today at the 21-percent lower rate, on a first in/ first out flow basis.
Once H.R. 3962 is passed by the House and signed by the President, CMS will retroactively adjust any June claims that have been paid.
Update: June 17, 2010
With the U.S. Senate rejecting a new spending bill on Wednesday that included a 19-month fix for Medicare physician payments, there is word of a more scaled-back version that provides shorter-term relief.
The new version would roll back last year's $25-a-week increase in unemployment checks and give doctors just a six-month reprieve from scheduled cuts in their Medicare payments instead of relief through 2011.
Media reports said the scaled-back bill might be up for a final vote by Friday.
AMA and TMA officials ask physicians to urge Congress to take immediate, permanent action to stop the cuts now and address the SGR in a meaningful and responsible manner. Physicians can use the AMA Grassroots Hotline, 800-833-6354.
Watch the TMA's Twitter and Facebook sites for the latest updates on the Medicare/SGR situation.
Update: June 11, 2010
Tuesday, June 15, is the earliest the U.S. Senate can resume voting on amendments to a bill that includes another postponement of severe Medicare physician pay cuts.
That from AMA and TMA officials, who are asking physicians to call Congress and urge them to take immediate action to stop the cuts now and address the SGR in a meaningful and responsible manner. Physicians can use the AMA Grassroots Hotline, 800-833-6354.
“It is imperative that Congress understands how its mismanagement of the Medicare program is wreaking havoc on physician practices and jeopardizing access to care for seniors and military families,” said AMA officials.
CMS Payments
To avoid disruption in the delivery of health care services to beneficiaries and payment of claims for physicians, non-physician practitioners, and other providers paid under the MPFS, CMS had instructed its contractors to hold claims for services paid under the MPFS for the first 10 business days of June (i.e., through June 14, 2010). This hold only affects MPFS claims with dates of service of June 1, 2010, and later.
Given the possibility of Congressional action in the very near future, CMS is now directing its contractors to continue holding June 1 and later claims through Thursday, June 17, lifting the hold on Friday, June 18.
Background
This week the Senate began consideration of H.R. 4213, the “American Jobs and Closing Tax Loopholes Act of 2010," which includes a 19-month suspension of the looming 21-percent Medicare physician payment cuts produced by the sustainable growth rate (SGR) for 19 months. The Senate version of the bill would provide a 2.2-percent update to physician payment rates for the rest of 2010, and an additional one-percent update for 2011. In 2012, the underlying SGR payment formula would resume and physicians would face a 33-percent cut in Medicare payment rates. This proposal is estimated to cost $22.9 billion over 10 years. The Senate package also restored a six-month extension (through June 30, 2011) of increased federal Medicaid funding that was originally included in the stimulus legislation. This provision costs $24.2 billion over 10 years.
Sen. John Thune (R-SD) offered a complete substitute amendment to the entire package on behalf of Senate Republicans. This proposal would provide two-percent Medicare physician payment updates for the remainder of 2010, and in 2011 and 2012. While CBO has not provided information on the size of the 2013 cut, the AMA estimates it would exceed 33 percent. This proposal would also cut Medicare physician payments by an additional four percent in 2014. The provision is estimated to cost $43.3 billion over 10 years, offset by a variety of medical liability reforms, including caps on noneconomic damages, expert witness qualifications, alternative dispute resolution provisions, and a fair-share rule for multiple defendants. CBO scored these provisions as saving $49.7 billion over 10 years.
Senate Schedule
There are reports the Senate will hold a cloture vote on Wednesday in an attempt to end debate on H.R. 4213. Thus, final Senate action on this package cannot occur until well into next week, and may lead to further delays if the package is not swiftly passed by the House and/or is revised and sent back to the Senate.