Congress fails to pass Medicare pay patch, CMS to hold claims
Congress fails to pass Medicare pay patch, CMS to hold claims
posted 12.21.11
The U.S. House of Representatives has rejected a Senate-approved bill that would have provided a short-term fix to avert a 27.4 percent cut in the Medicare physician payment rate. As a result, the cut will go into effect on Jan. 1.
The House rejected the Senate’s tax bill by a vote of 229-193-which included an extension of the Sustainable Growth Rate for two months-and instead called for a conference committee to iron out the differences. The Senate is adjourned until Jan. 23 and will not appoint conferees in time to avert the cut.
House leaders said the Senate bill “failed to provide an adequate extension of certain provisions, including a federal payroll tax holiday, an extension of a year-old freeze of federal salaries, and reform of the unemployment insurance system,” AAFP News Now reports. House members passed a bill on Dec. 13 that would have provided a 1 percent increase in Medicare payment for the next two years, financed by scaling back programs enacted by federal health reform. This made the bill unacceptable to Senate Democrats.
“AAFP is outraged that Congress failed to prevent the 27.4 percent Medicare physician pay cut mandated by current law,” said AAFP President Glen Stream, M.D., M.B.I., of Spokane, Wash., in a statement. “That failure has presented their elderly and disabled constituents a bitter holiday gift-uncertainty about whether their physicians will be able to provide the services they need.
“Regardless of whether Congress will retroactively make up this devastating loss of practice income next year, federal lawmakers’ failure to act will cause grave disruption in physician practices. Nearly one in four patients seen by family physicians is a Medicare beneficiary. For some family physicians, Medicare patients comprise as much as eight in 10 of their patients. No business can sustain such immediate and draconian cuts to their revenue.”
The Centers for Medicare and Medicaid Services has issued guidance to its Medicare claims administration contractors to hold payments for services billed for the first 10 business days of the year, Jan. 1 to Jan. 17. This should have “minimal impact” on physicians' cash flow since carriers routinely take 10 business days to process electronic payments, according to a CMS bulletin. The agency will notify physicians and stakeholders on or before Jan. 11 with more information.
By withholding payments, CMS is trying to make sure payments are not made at the lower rate until as late as legally possible, an AAFP bulletin reports. However, if Congress does not address the SGR by Jan. 17, CMS will have no choice but to direct payment at the reduced rate.
AAFP continues to advocate for the repeal the SGR; three-to-five years of specified, stable payments during which new payment models would be tested; and a higher fee-for-service payment rate for primary care physicians who offer primary care services.
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