Important Notice: Physician Billing and Medicare for April 1, 2014 – Mid-April (3/30/2015)
The current Sustainable Growth Rate (SGR) payment patch expires on April 1, long before Congress reconvenes and the Senate votes on the H.R. 2. As members likely know, last week, the U.S. House of Representatives, in a rare demonstration of bipartisanship, voted 392-37 to pass H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The Senate is expected to vote on the measure in mid-April following a two-week recess. After 14 years and 17 short-term patches, H.R. 2 – which is strongly supported by the AAO-HNS – will provide much-needed stability for physicians and their patients by permanently repealing the flawed SGR formula used to determine Medicare payments. Until the Senate votes, 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. 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, the AMA recommends 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.
Health Policy Attends December MedPAC Meeting (1/13/2015)
As members know, the Medicare Payment Advisory Commission (MedPAC) is the independent commission charged with annually reviewing Medicare payment policies and making recommendations to Congress based on its review and findings. MEDPAC held meetings on December 18 and 19th to discuss preliminary draft recommendations to Congress that it will revisit in March when it drafts its annual report. Health Policy staff were in attendance and have summarized relevant topics discussed. Click here to view the summary.