Dreams of permanent pay fix fade as House passes one-year SGR fix; ICD-10 also faces potential delay

March 27th, 2014 - Scott Kraft   
Categories:   Diagnosis Coding   Medicare Physician Fee Schedule (MPFSDB)   Reimbursement  
0 Votes - Sign in to vote or comment.

Leaders on Capitol Hill spent so much time debating, discussing and even reaching a tentative deal on a permanent repeal to the Sustainable Growth Rate (SGR) formula that has caused so much payment uncertainty for physician practices that people started to think it would actually happen.

It looks like those thoughts were premature, as a breakdown in discussion has led to yet another temporary, one-year freeze to physician payment rates that would take effect on April 1, 2014 and extend through March 31, 2015.

The one-year extension passed the House of Representatives on a voice vote on March 26, and is awaiting action in the Senate. The current, temporary payment fix, which ironically was supposed to provide extra time for a permanent fix, is set to expire March 31, 2014. With no action, physician payments would drop by more than 20%.

In addition to the payment fix, the bill also imposes a one-year delay on ICD-10-CM diagnosis code implementation by preventing CMS from recognizing it prior to Oct. 1, 2015.

While there are no guarantees until the Senate passes the bill and it is signed by the President, the House passed it on a voice vote and there are indications that House and Senate leaders have agreed to the legislation.

Most physician specialty groups oppose the bill, despite the one-year ICD-10 delay, because of the lack of a permanent payment fix.

In addition to the SGR fix and ICD-10 delay, the bill would continue to give temporary extensions to the 1.0 minimum work GPCI floor and the therapy cap exceptions process that enables providers to get fairly liberal exemptions beyond the therapy limits.

Some other interesting provisions in the legislation:
  • Deduction limits on employer sponsored health plans would be eliminated.
  • Private sector lab payments would be reported to CMS starting in 2016 and used to calculate Medicare’s lab payments. The labs would report the data, which would be used to set a weighted median payment for Medicare.
  • Payments would be reduced for the technical component of imaging tests done not using imaging equipment up to standard, a change designed to promote quality that would be effective in 2016. Reductions would be 5 percent in 2016 and 15 percent in 2017 and beyond.
  • CMS would be authorized to collect the inputs used to set relative value units from any reliable source and use the information to help set the values. Information could come from provider surveys and electronic health records, among other places. CMS is authorized to pay for the information.

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Coding for a Performance of an X-ray Service vs. Counting the Work as a Part of MDM
March 21st, 2022 - Stephanie Allard , CPC, CEMA, RHIT
When x-rays are audited on the same date as an E/M encounter we have one of three decisions to make about the work that went into the radiological exam when the practice owns x-ray equipment and does their own interpretations internally. First, we must determine whether the x-ray was...
Continuous Glucose Monitoring (CGM) Systems: Leveraging Everyday Tech to Enhance Diabetes Management
March 16th, 2022 - Susan Gatehouse, RHIT, CCS,CPC, AHIMA-Approved ICD-10-CM/PCS Trainer
However, is the coding for the treatment and management of diabetes being adequately captured? Diabetes mellitus (DM) affects over 400 million people worldwide. It is a chronic disease of inadequate control of blood levels of glucose that affects the body’s ability to turn food into energy. Essentially, the...
ESRD Hemodialysis Hits Home with the New ETC Model
March 16th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
In 2021, two major ESRD programs became effective, essentially preparing to transform not only risk adjusted services, but also at-home dialysis, health equity among beneficiaries needing transplant services, and improved access to donor kidneys.
Refresh Your IV Hydration Coding Knowledge
March 16th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Reporting IV infusion services can be complicated, especially when multiple infusions are reported in a single encounter. Take a few minutes to freshen up your knowledge on IV hydration coding with a review of the guidelines and a few coding scenarios.
Medicare Auditors Caught Double-Dipping
March 14th, 2022 - Edward Roche, PhD, JD
Overlapping extrapolations require providers to pay twice. Some Medicare auditors have been caught “double-dipping,” the practice of sampling and extrapolating against the same set of claims. This is like getting two traffic tickets for a single instance of running a red light. This seedy practice doubles the amount...
Cybersecurity & Ransomware Warnings
March 10th, 2022 - Wyn Staheli, Director of Content
Although HIPAA Security protocols have been in effect for some time, as technology advances, if we are not diligent, gaps can be left available for intruders. On top of that, on February 23, 2022, the American Hospital Association issued a cybersecurity advisory. They stated, “there is concern that Russia may retaliate against the U.S. and allied nations with disruptive cyberattacks.”
The Case of the Missing Signature
March 10th, 2022 - David M. Glaser, Esq.
It’s important to remember that Medicare manuals are not binding, and they can’t “require” anything, including signatures. Regulatory framework is constantly changing. Never assume you know all of the rules, even if you carefully study them all the time. New things are constantly appearing....



Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2022 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association