Congress has passed a temporary patch for the Medicare Sustainable Growth Rate (SGR) issue to prevent a 21% cut in Medicare physician reimbursement, however, the current patch expires May 31, 2010 so the work on this issue must continue.
The House Ways and Means Committee is continuing its work on a revised version of the tax extenders bill passed by the House and Senate H.R. 4213, which included a SGR patch until September 30, 2010. The Chairman of the Committee, Sander Levin (D-MI) has stated his intent to move this legislation prior to Memorial Day. The challenge, however, is finding an acceptable pay-for to off-set the cost of extending the tax cuts included in the bill even though it is yet again only another temporary fix. Further, it is concerning to think we could have to address this issue again just before the November elections. I am hoping we see the length of the temporary fix extended at least though the elections or through 2011. Physician groups such as the AMA are pushing for a permanent fix but given the cost of this issue a longer-term temporary fix may be a better option at this point.
On a related issue, Senate Democrats released their 2011 budget proposal last week, which continues to exempt the a fix of the Medicare Physician payment system (SGR) from Statutory-Pay-As-You-Go Act. The language specifically exempts the cost of a 5 year zero percent update from having to be paid for. This does not mean that the Congress must pass a 5 year zero percent freeze as they could do a shorter extension with a higher update just so long as it did not exceed the cost estimated by CBO for a 5 year zero percent update.
Will this issue get addressed in a more sustainable way? We all understand the current budget pressures but to put physicians and Medicare beneficiaries in the middle of these issues is not appropriate.
Monday, April 26, 2010
Thursday, April 15, 2010
Temporary "DocFix" is Approved through May 31st
Good news -- but its another short term fix.
Tonight, Congress has passed and President Obama has signed a Medicare physician payment bill that extends the 2009 physician payment rate until May 31, thus reinstating the payment rate that was in place on March 31. This will allow CMS to rescind a 21.2 percent reduction that went into effect on April 1 because of the sustainable growth rate, or SGR, formula.
CMS held payment of claims from April 1-15, awaiting passage of the payment legislation. The Senate, however, was unable to pass the Medicare payment bill before the 21.2 percent cut started to take effect.
CMS will instruct its contractors to retroactively reprocess any claims that were paid at the lower rate. Claims with dates of service prior to April 1, 2010, are not affected and will continue to be processed under normal procedures.
Good news for tonight but a longer term fix is needed!
Tonight, Congress has passed and President Obama has signed a Medicare physician payment bill that extends the 2009 physician payment rate until May 31, thus reinstating the payment rate that was in place on March 31. This will allow CMS to rescind a 21.2 percent reduction that went into effect on April 1 because of the sustainable growth rate, or SGR, formula.
CMS held payment of claims from April 1-15, awaiting passage of the payment legislation. The Senate, however, was unable to pass the Medicare payment bill before the 21.2 percent cut started to take effect.
CMS will instruct its contractors to retroactively reprocess any claims that were paid at the lower rate. Claims with dates of service prior to April 1, 2010, are not affected and will continue to be processed under normal procedures.
Good news for tonight but a longer term fix is needed!
Wednesday, April 14, 2010
Frustration Surges: Senate fails to approve temporary "doc fix" to prevent 21.3% fee cut -- but expected to fix it this week
Tonight the Senate failed to approve an amended version of H.R. 4851 which would continue the current Medicare physician reimbursement payment freeze until June 1.
Based on the previously announced schedule by CMS, Medicare contractors will begin processing impacted claims on Thursday, April 15th to ensure timely claims payment but at the new reduced fee level. These claims will have to be retroactively corrected once the Senate finally addresses this issue. The Senate is expected to return to consideration of this amended version of H.R. 4851 tomorrow. However, since the version of the extension legislation the Senate is considering is not identical to the version passed by the House on March 17, the House must approve this Senate passed version before sending it to the president for his signature.
Earlier today, the House Rules Committee approved a rule allowing for swift consideration of this amended version of H.R. 4851. The House is expected to act on this legislation later this week.
The Centers for Medicare and Medicaid Services (CMS) previously indicated that if legislation was not enacted by midnight April 14, Medicare contractors would begin processing the held April 1 claims. Once final legislation regarding the Medicare payment freeze is passed, we anticipate CMS issuing an official statement and details related to correcting these reduced levels of reimbursement.
Clearly this is frustrating news from Washington DC tonight -- especially since Senators believe this can be addressed this week. We all know this type of claims "rework" is costly and the gap in reimbursement is unacceptable so please call your Senator and urge action now.
Based on the previously announced schedule by CMS, Medicare contractors will begin processing impacted claims on Thursday, April 15th to ensure timely claims payment but at the new reduced fee level. These claims will have to be retroactively corrected once the Senate finally addresses this issue. The Senate is expected to return to consideration of this amended version of H.R. 4851 tomorrow. However, since the version of the extension legislation the Senate is considering is not identical to the version passed by the House on March 17, the House must approve this Senate passed version before sending it to the president for his signature.
Earlier today, the House Rules Committee approved a rule allowing for swift consideration of this amended version of H.R. 4851. The House is expected to act on this legislation later this week.
The Centers for Medicare and Medicaid Services (CMS) previously indicated that if legislation was not enacted by midnight April 14, Medicare contractors would begin processing the held April 1 claims. Once final legislation regarding the Medicare payment freeze is passed, we anticipate CMS issuing an official statement and details related to correcting these reduced levels of reimbursement.
Clearly this is frustrating news from Washington DC tonight -- especially since Senators believe this can be addressed this week. We all know this type of claims "rework" is costly and the gap in reimbursement is unacceptable so please call your Senator and urge action now.
Friday, April 2, 2010
Health Reform Could Increase Medigap Cost-Sharing for Seniors
Patient advocates are expressing new concerns that the language in the health reform bill will hit Medigap plans with higher cost-sharing requirements and would likely lead to increased copays starting in 2015 for the two most popular types of Medigap plans, Plans C and F.
Some health care experts worry the provisions, targeted for their savings and the hope that extra out-of-pocket costs will reduce unnecessary medical services, would unfairly hurt patients newly enrolling in the program.
Currently, Medigap policies pay the full 20 percent of cost-sharing for physician care and other outpatient Part B services, but the new law indicates that patients have to pay some of the cost sharing in order to reduce unnecessary medical care. Since there is no cap on the Medicare Part B copayment, many seniors prefer Medigap plans C and F as they cover all of those costs. Such coverage is critical for chronically ill patients and cancer patients.
Clearly, this will be one several key issues that impact patient copayment exposure and related access to care.
Some health care experts worry the provisions, targeted for their savings and the hope that extra out-of-pocket costs will reduce unnecessary medical services, would unfairly hurt patients newly enrolling in the program.
Currently, Medigap policies pay the full 20 percent of cost-sharing for physician care and other outpatient Part B services, but the new law indicates that patients have to pay some of the cost sharing in order to reduce unnecessary medical care. Since there is no cap on the Medicare Part B copayment, many seniors prefer Medigap plans C and F as they cover all of those costs. Such coverage is critical for chronically ill patients and cancer patients.
Clearly, this will be one several key issues that impact patient copayment exposure and related access to care.
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