SGR Update: Agreement Reached on Extension of SGR Fix

Senate leaders reached agreement today on a six-month extension of a fix for the Medicare physician payment rate. In telephone conversations with US Senator Richard Burr’s office, the NCMS learned that the plan is the result of an agreement reached between Senators Grassley and Baucus.

Under the proposal, the six-month fix would run June 1 to November 30, 2010 and include a 2.2% physician payment update, fully covered through pension revisions included in the Thune substitute amendment, which Republicans voted for on Thursday, with language clarifying the three-day payment window for hospitals (included in the Baucus substitute).

The Senate passed the legislation by early Friday afternoon, but the House is not in session and will not consider the measure until next week.  As the Senate acted on the legislation, the NCMS learned that Senate leaders were hoping the Centers for Medicare and Mediciaid Services would delay implementing a 21.2% cut in Medicare physician fees until Monday. 

However, published reports indicate that following Senate action, the Centers for Medicare and Medicaid Services announced it had begun processing Medicare claims received since June 1 at the lower rate. 

The NCMS continues to monitor developments involving Medicare physician payments and will provide  updates on the NCMS web site, http://www.ncmedsoc.org/.

If the cut is averted, the AMA says the CMS would direct Medicare contractors to process claims as follows:

(1) where the submitted charge is higher than the new rate, the contractor will automatically reprocess the claim; and

 (2) if the submitted charge is lower than the new rate, the physician should call the contractor.

CMS says almost all physicians submit claims for more than the Medicare rates. No one is going to be reviewing the limiting charge for the period that the cut was in place because CMS assumes Congress will ultimately make the fix retroactive.

Finally, the OIG and CMS are close to releasing a document to waive patient co-pay requirements for situations such as the retroactive increases that were made to the geographic practice cost index (GPCI) increases. CMS will share that document once it is available. 

Congress Hears from Organized Medicine

On Wednesday, the NCMS joined state medical societies and national specialty societies in sending a joint statement to Congress asking Senators and Representatives to resolve budget issues without punishing physicians, seniors and military families. The organizations stressed that “Congressional mismanagement of the Medicare program will force more physicians to stop accepting new Medicare and TRICARE patients, lay off staff, and defer investment in new medical equipment, health information technology, and other innovations that improve patient care.”

The NCMS urges physicians and their patients to sign the petition to Stop the Medicare Meltdown. Click here to download a flyer that will help explain the issues to patients.

 
 

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2 Comments

  • Adel mohamed,MD

    Repeal the SGR inaccurate formula.
    I will stop seeing Medicare and Tricare patients if you do act now.
    Our overhead expenses are increasing and our income is decreasing.
    That is formula for disaster. We have no choice but to cut services to the seniors and the military unfortunately

    Adel Mohamed,MD

  • michael silver

    Why Nov 30 and not Oct 30. Could it be the lashing out of senior voters at the poll? I hate to see the result after the election. Physicians can expect to make a lot less. We need the free market to reign and to remove the price controls that medicare has set.