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April 1 Medicare payment cut deadline; legislation to stop the cuts

AMA SGR Fix

Legislation that would stop the Medicare payment cuts and eliminate the Sustainable Growth Rate (DGR) formula that has created 17 funding crisis over the past 11 years overwhelmingly passed the US House of Representatives last week. (HR 2) Every member of the PA House Delegation voted to support the bill, so please thank your representative.

The US Senate did not act on the legislation before adjourning in recess early Friday morning. Senate Majority leader Mitch McConnell (R, KY) has indicated that this legislation will be among the first item of business when the Senate returns.

Continued strong grassroots advocacy is vital, and now is not the time to let up. Please take a moment to send a customizable email urging your Senators to pass H.R. 2 immediately upon their return to Washington D.C.

You may also call their District offices to urge support:

Senator Bob Casey
412-803-7370

Senator Pat Toomey
412-803-3501

Following is a statement from the American Medical Association that summarizes the situation and Medicare payment timetable:

Senate delays vote on SGR fix after House passes bipartisan bill

By a sizable majority, the House yesterday approved a bill to repeal Medicare’s sustainable growth rate formula. Coverage portrays the vote as a rare bipartisan victory for Congress and a win for both House Speaker Boehner and Minority Leader Pelosi. However, the AP (3/27) is reporting this morning that the Senate “has delayed giving final congressional approval to bipartisan legislation permanently blocking Medicare cuts for physicians until next month.” According to the article, leaders decided to wait until after Congress’ two-week spring recess to finish the legislation. Physicians are scheduled to be hit with Medicare cuts April 1, but the “government can delay processing the payments until lawmakers return.”

 

Congress is now adjourned for its April recess.  In statements made on the floor, Senate leaders said they will bring the bill up promptly when Congress returns from its recess on April 13.   According to remarks made by Majority Leader Mitch McConnell (R-KY) shortly after 3:00 am, “It’s encouraging this passed the House with such a large bipartisan majority, and I want to assure we’ll move to it very quickly when we get back…..I think there is every reason to believe it’s going to pass the Senate by a very large majority.”

 

Of course, the current payment patch expires on April 1, long before Congress reconvenes.  As a result, all physician services provided on or after April 1 will be subject to a cut of 21 percent.  The Centers for Medicare & Medicaid Services (CMS) is instructing its carriers to “hold” for 10 business days any claims for services provided on April 1 and beyond, until legislation can be passed and signed into law that reverses the 21 percent cut.  The 10-business-day hold means that April claims will be held through Tuesday, April 14.  Since no claims by law can be paid sooner than 14 calendar days from their receipt, this hold should have little practical impact on Medicare remittance in the short-term, although billing for copayments and claims reconciliation will be more complicated. 

 

In the meantime, some practices are asking what they should charge.  By law, Medicare is required to pay physicians the lesser of the submitted charge or the Medicare approved amount.  For this reason, the AMA is advising against submitting claims with reduced amounts reflecting the 21 percent cut.  Instead, we recommend physicians either continue charging the current 2015 rates for April dates of service or defer submitting claims until after final action on the legislation. In the unexpected event that Congress allows the 21 percent cut to take effect, Medicare would pay physicians at the reduced amount no matter what the physician billed and no further action would be necessary.   However, non-participating physicians who have collected balance billing amounts for unassigned claims based on the currently-allowed amount could be required to make refunds to their patients based on new, lower balance billing limits.

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Allegheny County Medical Society
713 Ridge Avenue
Pittsburgh, PA  15212
412-321-5030  FAX 412-321-5323