SGR Fix Still Under Review in the Senate

After completing a lengthy round of votes on the budget resolution, a handful of Senators blocked efforts to reach agreement on the rules for debate of HR 2, the “Medicare Access and CHIP Reauthorization Act,” which passed the House on March 26 by an overwhelming margin of 392-37. Congress is now adjourned for its April recess. In statements made on the floor, Senate leaders said they will promptly bring up the bill when Congress returns from its recess on April 13. While some Senators expressed reservations or opposition to the bill, it does appear that there are enough supporters to pass the bill upon their return. Despite strong indications of support in the Senate, it would still be helpful if physicians were to continue to contact their Senators and urge them to pass the bill when they return. Thank you to all of the AMCNO members who contacted their representatives about this important issue.

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 21% cut. 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% 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 American Medical Association (AMA) is advising against submitting claims with reduced amounts reflecting the 21% cut. Instead, they 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% 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.

The Pollen Line is now closed. See you in the spring!

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