Despite Bipartisan House Support for SGR Repeal, Senate Delays Vote on Bill > Michigan State Medical Society


Despite Bipartisan House Support for SGR Repeal, Senate Delays Vote on Bill

After the U.S. House of Representatives last week overwhelmingly approved a bill to eliminate the flawed Medicare sustainable growth rate (SGR) formula, the U.S. Senate delayed giving its final approval to the bill. Senate leaders said they will wait until after Congress’ two-week April recess to vote on the legislation, citing the government’s ability to delay processing claims that reflect physician payment cuts scheduled to take effect on April 1.

The bill would set into motion Medicare physician payment reforms that will support physician practices that serve our nation’s seniors and military families enrolled in TRICARE. President Barack Obama said he would sign the legislation into law, intensifying pressure on the Senate to move the bill forward.

By law, doctors are to receive 21 percent cuts in Medicare reimbursements April 1. The government can delay processing the payments until lawmakers return. In a March 24 email to the American Medical Association from the Centers for Medicare & Medicaid Services (CMS), the administration said it "urges Congress to take action to ensure these cuts do not take effect."

"However, until that happens, CMS must take steps to implement the negative update,”"the email said. "Under current law, electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt. CMS will notify you on or before April 11, 2015, with more information about the status of Congressional action to avert the negative update and next steps."

Here's what physicians need to know about payments for Medicare services:

  • Technically, payments for Medicare services provided on or after April 1 will be subject to a cut until Congress passes a bill. Claims processed after April 1 for services provided before that date will not be cut.
  • Since electronic claims are not processed for 14 days (paper claims take 29 days), the impact of the cut will not be felt immediately.
  • Congress returns to Washington, D.C. on April 13 and plans to take up the bill promptly, so it is possible that the situation will be resolved before any claims are actually processed at the reduced rate.
  • MSMS and the AMA anticipate that when Congress passes a bill, the restored payment rates will be applied retroactively.

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Posted in: Federal Government News, Medicare, Hot Topics, Advocacy