Where Do We Stand With the SGR?

SGR-updateVery early on the morning of March 27, 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 on H.R. 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 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 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.”

While some Senators expressed reservations or opposition to the bill, we agree there were more than enough supporters to pass the bill.  It appears that an unfortunate combination of timing, budget amendment fatigue, and procedural obstacles having nothing to do with the policies set forth in H.R. 2 were working against us.

Of course, the current payment patch expires today, 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.

Watch the NCMS website and Bulletin where we will update you as information about the claims hold and further Senate action become available.

 
 

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