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.
Wednesday, April 14, 2010
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.
Friday, March 26, 2010
CMS will hold physician services claims for 10 business Days
Breaking news from CMS.
CMS has instructed its contractors to hold claims containing services paid under the MPFS (including anesthesia services) for the first 10 business days of April.
CMS has instructed its contractors to hold claims containing services paid under the MPFS (including anesthesia services) for the first 10 business days of April.
- This hold will only affect claims with dates of service April 1, 2010, and forward.
- In addition, the hold should have minimum impact on provider cash flow because, under the current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt
Senate fails to pass 30-day "doc fix" to prevent 21.3% Medicare payment cut for physicians effective April 1st
The Senate has adjourned for its two-week spring recess without approving H.R. 4851, a short-term measure that would have extended the freeze on Medicare’s current physician payment rates through April 30.
Several Senate Republicans led by Tom Coburn of Oklahoma objected to classifying the bill, which also included extensions of unemployment benefits and COBRA insurance, as emergency spending. The House of Representatives passed the bill on March 17. By law, the 21.3 percent cut to Medicare physician payments will take effect April 1.
However, in similar situations in the past, the Centers for Medicare & Medicaid Services (CMS) has instructed carriers to temporarily hold claims. While CMS has not made this announcement yet, we exect that CMS will hold claims for the first 2 weeks of April.
The Senate returns April 12 and has scheduled a cloture vote on the 30-day extension bill for 5:30 p.m. that evening. Physician offices should contact their Senators and urge them to permanently address this issue by repealing the sustainable growth rate (SGR) formula. This is frustrating and disappointing but as long as Congress acts on April 12th there will hopefully not be an impact for physicians due to the normal lag in claims processing by CMS.
Several Senate Republicans led by Tom Coburn of Oklahoma objected to classifying the bill, which also included extensions of unemployment benefits and COBRA insurance, as emergency spending. The House of Representatives passed the bill on March 17. By law, the 21.3 percent cut to Medicare physician payments will take effect April 1.
However, in similar situations in the past, the Centers for Medicare & Medicaid Services (CMS) has instructed carriers to temporarily hold claims. While CMS has not made this announcement yet, we exect that CMS will hold claims for the first 2 weeks of April.
The Senate returns April 12 and has scheduled a cloture vote on the 30-day extension bill for 5:30 p.m. that evening. Physician offices should contact their Senators and urge them to permanently address this issue by repealing the sustainable growth rate (SGR) formula. This is frustrating and disappointing but as long as Congress acts on April 12th there will hopefully not be an impact for physicians due to the normal lag in claims processing by CMS.
Tuesday, March 23, 2010
President signs Health Reform into Law; But Many Issues Remain
The President signed health care legislation into law today. Today's ceremonies followed a very busy weekend in Washington DC with the House approving late Sunday night the Senate Health Reform bill and Reconciliation Language.
The House took two separate votes on the reform legislation. First, the House passed - by a vote of 219 to 212 - HR 3590, the Patient Protection and Affordable Care Act, the bill approved by the Senate last December. The House then passed HR 4872, the Health Care and Education Affordability Reconciliation Act of 2010, by a vote of 220 to 211. This legislation modifies the Senate bill with a number of "fixes" negotiated over the last two months by the House and Senate. As expected, not a single House Republican voted in favor of either measure.
The contentious, year long health reform debate is not finished, however, as H.R. 4872 goes to the Senate, where only a simple majority is needed to approve the bill under the reconciliation process. The Senate will consider the modification bill under streamlined procedures that avoid time-consuming cloture motions to begin and end debate on the bill. Senate Republicans are expected to offer numerous amendments and raise multiple points of order to the legislation. If the bill is changed in any way prior to Senate approval, it must return to the House for an additional vote before the President can sign it. A timeline on the Senate debate of the reconciliation measure has not yet been officially released but is expected to proceed quickly given the upcoming Spring recess which is supposed to start at the end of the week.
Even with passage of the most historic health reform legislation since the enactment of Medicare, policy insiders anticipated a reinvigorated battle over the future of Medicare as the Senate considers the reconciliation language. Also expected on the horizon are appropriations funding battles for the provisions of the bill of discretionary spending provisions and threats of court cases in several states over requiring individuals to purchase health insurance.
The Senate this week will also consider a new short-term extension bill (HR 4851) to extend the delay in Medicare physician rate cuts until April 30. The current extension expires on March 30. The House approved the measure on Wednesday. The Senate approved a longer-term extension (HR 4213) earlier this month which is pending action in the House. This is one of several critical issues yet to be addressed. Next up...the real work begins on the implementation of health reform.
The House took two separate votes on the reform legislation. First, the House passed - by a vote of 219 to 212 - HR 3590, the Patient Protection and Affordable Care Act, the bill approved by the Senate last December. The House then passed HR 4872, the Health Care and Education Affordability Reconciliation Act of 2010, by a vote of 220 to 211. This legislation modifies the Senate bill with a number of "fixes" negotiated over the last two months by the House and Senate. As expected, not a single House Republican voted in favor of either measure.
The contentious, year long health reform debate is not finished, however, as H.R. 4872 goes to the Senate, where only a simple majority is needed to approve the bill under the reconciliation process. The Senate will consider the modification bill under streamlined procedures that avoid time-consuming cloture motions to begin and end debate on the bill. Senate Republicans are expected to offer numerous amendments and raise multiple points of order to the legislation. If the bill is changed in any way prior to Senate approval, it must return to the House for an additional vote before the President can sign it. A timeline on the Senate debate of the reconciliation measure has not yet been officially released but is expected to proceed quickly given the upcoming Spring recess which is supposed to start at the end of the week.
Even with passage of the most historic health reform legislation since the enactment of Medicare, policy insiders anticipated a reinvigorated battle over the future of Medicare as the Senate considers the reconciliation language. Also expected on the horizon are appropriations funding battles for the provisions of the bill of discretionary spending provisions and threats of court cases in several states over requiring individuals to purchase health insurance.
The Senate this week will also consider a new short-term extension bill (HR 4851) to extend the delay in Medicare physician rate cuts until April 30. The current extension expires on March 30. The House approved the measure on Wednesday. The Senate approved a longer-term extension (HR 4213) earlier this month which is pending action in the House. This is one of several critical issues yet to be addressed. Next up...the real work begins on the implementation of health reform.
Saturday, March 13, 2010
Health Reform -- Too Close to Call
Speculation is growing that Democrats do not yet have the votes necessary to pass a healthcare reform bill. At the same time, House Speaker Pelosi has signaled she will work to push through health reform well before the coming spring recess.
The House Democratic Caucus was reportedly told by their leadership this morning that there would be a single, closed health reform vote within the next week, to include the reconciliation provisions (amendments to the Senate health reform bill and a student aid package) and the Senate passed reform bill. The Senate bill vote is wrapped into the single vote, so when members vote for or against the reconciliation package they will also be voting for or against the Senate passed health reform bill. Once passed, the Senate bill would go to the President for signing, and the reconciliation provisions would go to the Senate where they must pass the provisions unchanged. The Senate Parliamentarian ruled earlier this week that the President must sign Congress' original health care reform bill before the Senate can act on a companion reconciliation package. Some speculate this new twist could create new challenges for health reform legislation.
The White House has been pressing for a vote next week, but lingering questions this week cast doubt on whether the House would vote on the reform provisions before Congress adjourns for two weeks on March 26th.
The House Democratic Caucus was reportedly told by their leadership this morning that there would be a single, closed health reform vote within the next week, to include the reconciliation provisions (amendments to the Senate health reform bill and a student aid package) and the Senate passed reform bill. The Senate bill vote is wrapped into the single vote, so when members vote for or against the reconciliation package they will also be voting for or against the Senate passed health reform bill. Once passed, the Senate bill would go to the President for signing, and the reconciliation provisions would go to the Senate where they must pass the provisions unchanged. The Senate Parliamentarian ruled earlier this week that the President must sign Congress' original health care reform bill before the Senate can act on a companion reconciliation package. Some speculate this new twist could create new challenges for health reform legislation.
The White House has been pressing for a vote next week, but lingering questions this week cast doubt on whether the House would vote on the reform provisions before Congress adjourns for two weeks on March 26th.
Senate Passes A 6-Month Fix to SGR Issues
Senate passes another temporary fix to SGR and Medicare Pay extenders This week the Senate passed another temporary Medicare physician payment patch by a vote of 62-36. The bill prevents a cut to Medicare physician reimbursement and instead holds payment levels flat until October 1, 2010. The legislation extends several programs related to unemployment and COBRA benefits, as well as other tax provisions and federal programs. It also includes language to delay DME accreditation requirements for pharmacies until January 2011 and exempts pharmacies where DME is less than 5% of sales.
The following lists some of the key health extenders contained in the American Workers, State, and Business Relief Act of 2010, as passed by the Senate:
The following lists some of the key health extenders contained in the American Workers, State, and Business Relief Act of 2010, as passed by the Senate:
- Provides a nine month extension of the 65% COBRA premium assistance (through December 31, 2010) and extends the enhanced Medicaid FMAP increase from the American Recovery and Reinvestment Act through 2010.
- Provides a six month extension of the 0% update to the 2010 Medicare physician fee schedule (through September 30, 2010).
- The 1.0 floor for the work geographic practice cost index (GPCI) used to help calculate the Medicare physician fee schedule update would remain in effect through 2010 which is important for rural physicians.
- Extends the Medicare exceptions process for outpatient therapy services through December 31, 2010.
- Extends for one year (to January 1, 2011) the date by which certain pharmacies must be accredited as durable medical equipment (DME) suppliers and allows HHS to establish alternative quality standards and accreditation requirements for pharmacies.
- Extends the Medicare mental health services 5% add-on payment through December 31, 2010.
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