As Friday's deadline looms, Congress has yet to pass SGR payment fix

Twitter icon
Facebook icon
LinkedIn icon
e-mail icon
Google icon

The Continuing Extension Act of 2010, enacted April 15, extended the zero percent update to the 2010 Medicare Physician Fee Schedule (MPFS) through May 31. Now, Congress is still debating the elimination of the negative update that took effect June 1; however, in hopes of legislation passing, the Centers for Medicare & Medicaid Services (CMS) is holding claims through June 17.

To avoid disruption in the delivery of healthcare services to beneficiaries and payment of claims for physicians, non-physician practitioners and other providers paid under the MPFS, CMS instructed its contractors on May 27 to hold claims for services paid under the MPFS for the first 10 business days of June (or through June 14). This hold only affected MPFS claims with dates of service of June 1 and after.

CMS directed its contractors to continue holding June 1 and later claims through June 17, lifting the hold on June 18. Therefore, the American Medical Association (AMA) pointed out that “unless Congress sends legislation averting the cut to President Barack Obama for signature within the next few days, carriers will begin processing claims with the 21 percent cut on June 18.”

The House passed a package last month that included a $22 billion, 19-month fix to the sustainable growth rate (SGR) formula. However, the Senate has struggled over the last few weeks to pass its version of the legislation, which would equate to a 2.2 percent increase in Medicare payment for the next seven months.

“The choice between not getting paid from Medicare at all or getting paid 79 percent of current rates places physicians between a rock and a hard place with no good options,” the AMA said. “If Congress fails to act before Friday, then carriers will start processing June claims at the reduced rates and whenever Congress does act, these claims will need to be reprocessed and retroactively adjusted.”

Therefore, the association recommended that to avoid the reprocessing, "practices that can afford it may wish to hold claims themselves until after the issue is resolved.”