Posts Tagged ‘Medicare Fee Schedule’

The Fix Is In… for 2012

In Uncategorized on February 29, 2012 at 5:12 pm

The House and Senate have both voted to approve, and the President has signed into law, legislation preventing the scheduled 27.4% SGR related cut from taking effect on March 1.   While many issues are in fact addressed in this legislation – ranging from outpatient therapy caps to ambulance add-on payments; from the governments provision of bad debt payments to insitutions to the payment of the technical component of certain pathology services, etc…, by far the most anticipated and relevant item impacted by the legislation is the Medicare Physician Fee Schedule rates:

Physician Payment Rates – This provision prevents a 27.4 percent cut in Medicare physician payment rates slated to begin on March 1, 2012, and instead freezes payment rates at their current level though December 31, 2012.  This provision also requires the Government Accountability Office (GAO) and HHS to submit reports to assist Congress in the development of a long-term replacement to the current Medicare physician payment system.

Physicians can breathe a sigh of relief, as physician payments are safe for the remainder of 2012…  but a permanent fix is an ever increasing necessity, for now, physician practices will face a mounting 35% payment threat from Medicare in 2013, absent additional furture Congressional intervention.


2012 Medicare Physician Fee Schedule Is In the Crosshairs Again… AKA, “The Perils of The SGR”

In Uncategorized on February 8, 2012 at 3:21 pm

Although most of us were not around during the era of silent movies, many of you may be familiar with a genre of movie referred to as a serial motion picture….  One of the more famous of this genre was titled, “The Perils of Pauline.”   In this series, the heroine, Pauline, would be put into a perilous situation (i.e. tied to the railroad tracks with a fast approaching train, tied to a barrel filled with explosives, etc.) and during the course of the installment, Pauline would miraculously escape near certain death at the last possible moment.  Each installment would end with words to the effect, “Tune in Next Week.”

Anyone familiar with “The Perils of Pauline” series cannot help but recognize the parallels between Pauline and healthcare providers as we watch our government deal with theSGR problem.  Every few months, it seems, Congress waits until the last possible moment to fix the SGR cut and avoid the financial calamity that would ensue if Congress allowed the cut to take effect. 

As we all know, in the latest “Perils of SGR,” Congress voted to delay any resolution of the SGR – and the potential 27% reduction in the Medicare Physician Fee Schedule — in late 2011.  However, that “fix” was only for two months and we were all told to, “Tune in next month,” as our intrepid Congress attempts to once again step in at the last minute to avoid yet another possible cut in physician fee schedule payments on March 1, 2012.  Unfortunately, whereas “The Perils of Pauline” was a movie, the perils of the SGR cut are all too real.

On January 24th a House-Senate Conference Committee met for the first time to begin formal work on resolving the SGR differences between the House and Senate.  Although this was the first meeting by the Representatives and Senators, their staffs had been meeting regularly leading up to this meeting.  The Conference Committee met again on February 1st and 2nd, and additional meetings are anticipated over the next few weeks, during which committee members are to present all ideas and solutions. 

Representative Renee Ellmers (R-NC), a freshman Member of Congress on the Conference Committee (and a healthcare executive prior to being elected to Congress in 2010) suggested a two-year extension for the SGR fix, thus giving the Congress time to find alternate solutions.  Follow-up remarks made by several members of the Conference Committee indicated that there was at least some bi-partisan interest in coming up with a permanent fix to the SGR rather than another in the long series of temporary fixes. 

The stumbling block for enacting a permanent SGR solution has not been the lack of an alternative formula, but rather how to pay for any fix the Congress might adopt.  Current estimates are that adopting a permanent fix would increase the federal deficit by approximately $300 billion over the next year unless corresponding spending reductions were made to offset the debt. 

The AMA and some other organizations have suggested that money saved by the ending of the war in Iraq could be used to pay for the SGRfix.  The current federal budget (which projects spending out for 10 years) assumed that theIraq war would go on for several more years and money was budgeted for that purpose.  However, with the ending of the war, the money previously budgeted will no longer be needed.  Therefore, from a budgeting standpoint, this money could technically be redirected to pay for the SGR fix, rather than being set aside for the war inIraq.  Doing so would not increase the projected federal deficit beyond current estimates as this would be viewed as a reprogramming of dollars already budgeted for another purpose.  It remains to be seen whether the Congress will pursue this budgetary line of reasoning or not. 

Although it appears unlikely that Congress would allow the 27% SGR-related cut to go into effect on March 1, there are no guarantees.  Stay tuned for the next installment…   

Adapted and reprinted with permission of Bill Finefrock, Washington Report – January 2012.

Medicare Physicial Fee Schedule Payments Safe Through 2010

In Uncategorized on December 6, 2010 at 5:07 pm

On Tue Nov 30, 2010, President Obama signed into law “The Physician Payment and Therapy Relief Act of 2010.”  This law extends through Fri Dec 31, 2010, the 2.2 percent update to the Medicare Physician Fee Schedule(MPFS) that has been in effect for MPFS claims with dates of service of Tue June 1, 2010, through Tue Nov 30, 2010.  Payments for 2010 services under the MPFS will continue without delay.

SGR Reprieve For Holidays

In Uncategorized on November 24, 2010 at 8:33 pm

Just a quick note to let everyone know that late last Thursday, (11/18) the Senate, by unanimous consent, approved a one-month extension of the current payment levels for Medicare Part B. This would avoid the 23% SGR related cut that is scheduled to go into effect on December 1. This temporary extension would postpone the SGR cut until January 1, 2011 unless Congress enacts another “fix” between December1, 2010 and January 1, 2011.

The House has already adjourned until after the Thanksgiving Holiday. However, late last night, House Majority Leader Steny Hoyer (D-MD) announced that he intended to bring up the 30 day extension when the House reconvenes on November 29th.

Majority Leader Hoyer released the following statement following Senate approval of the 30 day extension:

“It is my intention to schedule this bill for consideration when the House reconvenes on November 29th, so we can send it to the President’s desk prior to the November 30th expiration date of current SGR relief.”

Hoyer went on to say,

“This legislation allows Congress to continue our work on a longer- term solution – one which provides our seniors with the security of continued access to the physician of their choice and our physicians with at least one full year of SGR relief.” 

 We’ll keep you posted as developments unfold. 

(Reprinted with permission, Bill Finerfrock, Capitol Associates)

Administration’s Bipartisan Commission on Fiscal Responsibility & Reform Recommends Restrictions On Provider Payments

In Uncategorized on November 12, 2010 at 4:38 pm

A proposal from the bipartisan National Commission on Fiscal Responsibility and Reform aims to direct the CMS to establish a new payment system for physicians; increase cost-sharing in Medicare; and enact comprehensive medical malpractice liability reform to cap noneconomic and punitive damages.

In what it called the “medium term,” the proposal would offset the so-called doc fix in a variety of ways, such as by paying physicians and other providers less and rewarding quality by hastening payment reforms and increasing drug rebates and by expanding cost-sharing in Medicare to promote consumer health choices and spending. For the long term, the plan seeks to contain growth in total federal health spending to the gross domestic product plus 1% after 2020 by “establishing a process to regularly evaluate cost growth and take additional steps as needed if projected savings do not materialize,” according to the report.

Commission Co-chairmen Erskine Bowles, former chief of staff to President Bill Clinton, and former Sen. Alan Simpson (R-Wyo.), released the 50-page proposal, which also attempts to realize healthcare savings by expanding accountable care organizations and payment bundling; cutting Medicare payments for bad debt; placing dual-eligible individuals in Medicaid managed care; increasing nominal Medicaid co-payments; cutting federal spending on graduate and indirect medical education; and converting the federal share of Medicaid payments for long-term care into a capped allotment.

At least 14 members of the 18-member commission, which was created by President Barack Obama, must approve the recommendations before the package can be sent to Congress for action.

 In a statement, the not-for-profit Committee for a Responsible Federal Budget, which focuses on educating the public about fiscal policy, called the proposal a “truly remarkable plan,” saying it would cut the deficit to 2.2% of GDP by 2015; lower national debt by 60% by 2024; and balance the budget by 2037. “The co-chairs’ proposal underscores the depth and breadth of reforms that must be made to the budget if we are to set the foundation for a stronger economy down the road,” Maya MacGuineas, president of the committee, said in a news release. “Yes, some of these changes will be painful—there’s no denying that,” she added. “But we must be mindful of the consequences if we fail to act.”

The American Public Is Concerned About Looming Medicare Fee Schedule Cuts

In Uncategorized on November 9, 2010 at 7:22 pm

The overwhelming majority, 94%, of American adults age 18 and older feel the looming Medicare physician payment cut poses a seiours problem for seniors who rely on Medicare. This number jumped to 98 % of those age 55 and older.

Not surprisingly, therefore, four out of five adults – 81% – stated that Congress should act immediately to stop the Medicare physician payment cut.  This number increased to 91% and 95% for adults over age 55 and over age 65, respectively.This poll was released Monday by the American Medical Association (AMA) at the organization’s semi-annual meeting of physician leaders.

“Our new poll sends a message to Congress that the American people want them to stop the Medicare cut with 95 percent of seniors saying Congress should act immediately to stop it,” said AMA President Cecil B. Wilson, MD, at a news conference. “On December 1 the cut begins, and if Congress has not acted seniors will suffer. We’re pulling out the stops to get Congress to act.”

Wilson said AMA plans to run a new ad in USA Today and in Washington, D.C., publications next week calling for lawmakers to stop the pay cut.

“Physicians want to care for seniors, but it is nearly impossible for many physicians to keep their practices open to all Medicare patients when they face a 25 percent payment cut,” Wilson said.

“The roller coaster ride caused by Congress’ inability to stop the cut for at least a year is eroding physicians’ confidence and commitment to Medicare-right during Medicare’s open enrollment season for physicians,” he said. “There is a growing concern that Medicare is becoming an unreliable payer.”

Wilson said AMA is calling for Congress to stop the cut for at least 13 months, allowing lawmakers to work out  a permanent solution.

Medicare Claims Processing (For Dates Of Service Post-June 1st) On Hold Again

In Uncategorized on June 25, 2010 at 5:34 pm

As mentioned in our last post, the House approved legislation last night rescinding the 21.3% SGR cut and replacing it with a 2.2% increase. This increase is retroactive to claims for services provided on or after June 1, 2010 and will be in place for services provided through November 30, 2010.

The Centers for Medicare & Medicaid Services (CMS) has directed Medicare claims contractors to discontinue processing claims at the negative update rates and to temporarily hold all June 1 or later claims for services until the new 2.2 percent update rates are tested and loaded into the Medicare contractors’ claims processing systems.  According to a statement from CMS, “We 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 not reflect the 2.2% increase but will continue to be processed.

CMS has also announced that claims containing June 2010 dates of service which have already 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 upon the lesser of the submitted charge on the claim or the MPFS amount. 

Please take note that 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.  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.  According to CMS, “Providers should not resubmit claims already submitted to their Medicare contractor.”

While we appreciate the steps Congress has taken to address the SGR problem, this is still only a temporary solution and the Congress must enact a permanent fix to the SGR.  Because this fix is only for 6 months, providers will be facing a reinstatement of the 21.3% cut on December 1, 2010.  Then, a SGR second cut, estimated at 25%, will occur on January 1 unless Congress takes steps to prevent these cuts from occurring.

We’ll keep you posted…

SGR Update – Bill “Fixing” SGR Before The President

In Uncategorized on June 25, 2010 at 2:46 am

Following last week’s action by the Senate, the House has just passed legislation, H.R. 3962, which would “fix” the SGR problem (and table the Medicare Physician Fee Schedule cut) for the next 6 months.  Retroactive to services delivered on or after June 1, the Medicare Conversion Factor will be raised by 2.2%.  This will be in place for services provided between June 1, 2010 and November 30, 2010.  The bill has been sent to the President for his signature.

However, unless Congress takes steps between now and November 30th, the 2.2% increase will cease on December 1, 2010 and the 21.3% reduction will be restored.

CMS Directs Payments With 21.2% MPFS Cut

In Uncategorized on June 18, 2010 at 7:49 pm

The CMS has confirmed that it has directed Medicare contractors to begin processing physician reimbursements for the month of June with the scheduled 21.2% cut mandated by law…

21% Cut To Medicare Pysician Fee Schedule Implemented

In Uncategorized on June 18, 2010 at 4:48 pm

Sadly, the Senate failed to pass a bill Thursday that would stall a 21 percent Medicare physician pay cut.   

As the Senate struggles to pass the Jobs and Closing Tax Loopholes Act of 2010 (potentially up for a vote next week), which contains a six-month delay of the pay cut, physicians face uncertainty on reimbursement.  Current law mandates a 21 percent Medicare pay cut as of June 1, 2010. 

Meanwhile, the Centers for Medicare and Medicaid Services had placed a hold on claims submitted for dates of service of June 1st or later.  That hold expired Thursday and CMS contractors will begin processing claims according to the mandated 21 percent cut today.  In the event that the Medicare Physician Fee Schedule cut is repealed retroactively to June 1st (which is ultimately expected), CMS contractors will automatically reprocess all claims with dates of service on June 1, 2010 or later (and thus subject to the fee cut) to capture that additional payment. 

Needless to say, let the administrative bookkeeping games begin!