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American Academy of Family Physicians
Friday Jun 18, 2010

The Senate finally passes a temporary SGR fix -- too late to stop the cut

It had to happen sometime: The Senate has finally taken a step toward ending the 21.3 percent cut in Medicare payments that is currently in effect. A short time ago, the Senate majority leader, Sen. Harry Reid (D-Nev.), announced a unanimous consent agreement to raise Medicare payments to physicians by 2.2 percent for a period of six months. The House still has to act for the increase to go into effect, though, and the House isn't scheduled to be in session again until Tuesday. In recent months, the House has tended to be more favorable than the Senate to "SGR fixes" designed to postpone the payment cut, so the news could be good – if a six-month patch can be called good.

That's the end of the good news. The bad news is that the Senate acted just too late to prevent the cut from showing up in physician payments. The Centers for Medicare & Medicaid Services (CMS) has instructed Medicare carriers to start paying June claims in the order of submission and at the 21.3 percent lower rate. The axe has finally fallen. Here's the text of the CMS statement on the matter:

The Continuing Extension Act of 2010, enacted on April 15, 2010, extended the zero percent update to the 2010 Medicare Physician Fee Schedule (MPFS) through May 31, 2010.

On May 27, 2010, the Centers for Medicare & Medicaid Services (CMS) initially instructed contractors to hold claims for services paid under the MPFS for the first 10 business days of June.  On June 14, CMS extended this hold for an additional three business days (i.e., through June 17, 2010).  This hold only affected MPFS claims with dates of service of June 1, 2010 and later. 

The CMS today directed contractors to lift the hold and begin processing June 1 and later MPFS claims under the law’s negative update requirement.  Held claims will be released and processed on a flow basis, first-in/first-out.

Congress continues to debate the elimination of the negative update that took effect June 1, 2010.  The CMS is hopeful that Congressional action will be taken to avert the negative update.  We continue to monitor Congressional actions, and if Congress changes the negative update that is currently in effect, we are prepared to act expeditiously to make the appropriate changes to Medicare claims processing systems.

Keep your fingers crossed. With luck, the House will support the Senate's action and replace the large cut with a small increase as early as Tuesday evening. 

Tuesday Jun 15, 2010

Timeline of regulations affecting physicians

Need help keeping track of all the legislative and compliance deadlines affecting your medical practice? Family Practice Management has compiled the following timeline, which will be updated regularly.

2011

Jan. 1: Medicare bonus for primary care
Primary care physicians will begin receiving a 10-percent quarterly bonus from Medicare if at least 60 percent of their Medicare charges are for primary care services. The bonus ends Dec. 31, 2015.

Jan. 1: E-Prescribing
The 2011 bonus payment for successful participation in Medicare’s e-prescribing incentive program is 1 percent, with a 1-percent payment reduction for those who do not comply.

Jan. 1: PQRI
The 2011 incentive for participation in the PQRI program is 1 percent; an additional 0.5 percent incentive is available for participation in a continuous assessment program, such as maintenance of certification.

Jan. 1: Meaningful Use
Beginning in 2011, physicians who demonstrate meaningful use of electronic health records could qualify for up to $44,000 in Medicare incentive payments.

March 31: PQRI
This is the last day to submit data for the 2010 PQRI and be eligible for a 2-percent Medicare bonus.

Oct. 1: ICD-9
New ICD-9 codes and revisions go into effect for 2011-2012.

Dec. 31: HIPAA
Providers must have completed external testing of the HIPAA version 5010 electronic standards with their business partners.

2012

Jan. 1: E-Prescribing
The 2012 bonus payment for successful participation in Medicare’s e-prescribing incentive program is 1 percent, with a 1 percent payment reduction for those who do not comply.

Jan. 1: PQRI
The 2012 incentive for participation in the PQRI program is 0.5 percent; an additional 0.5 percent incentive is available for participation in a continuous assessment program, such as maintenance of certification.

March 31: HIPAA
Providers must begin using the HIPAA version 5010 electronic standards when submitting claims to Medicare and private payers.

2013

Jan. 1: E-Prescribing
The 2013 bonus payment for successful participation in Medicare’s e-prescribing incentive program is 0.5 percent, with a 1.5 percent payment reduction for those who do not comply.

Jan. 1: PQRI
The 2013 incentive for participation in the PQRI program is 0.5 percent; an additional 0.5 percent incentive is available for participation in a continuous assessment program, such as maintenance of certification.

Jan. 1: Medicaid payments
In 2013 and 2014, all Medicaid payments for primary care services will be increased so that they are at least equal to Medicare payments.

Oct. 1: ICD-10
ICD-10-CM goes into effect.

2014

Jan. 1: E-Prescribing
Bonus payments for successful participation in Medicare’s e-prescribing incentive program cease; a 2-percent payment reduction begins for those who do not comply.

Jan. 1: PQRI
The 2014 incentive for participation in the PQRI program is 0.5 percent; an additional 0.5 percent incentive is available for participation in a continuous assessment program, such as maintenance of certification.

2015

Jan. 1: Meaningful Use
Providers who have failed to demonstrate meaningful use of electronic health records will be penalized with a 1-percent Medicare payment reduction.

Jan. 1: PQRI
A 1.5 percent penalty goes into effect for providers who do not participate in the PQRI program.

Dec. 31: Medicare bonus for primary care
The 10-percent Medicare bonus for primary care physicians ends.

2016

Jan. 1: Meaningful Use
Providers who have failed to demonstrate meaningful use of electronic health records will be penalized with a 2-percent Medicare payment reduction.

Jan. 1: PQRI
A 2-percent penalty goes into effect for providers who do not participate in the PQRI program.

2017

Jan. 1: Meaningful Use
Providers who have failed to demonstrate meaningful use of electronic health records will be penalized with a 3-percent Medicare payment reduction. (The Secretary of Health and Human Services has the option of extending the penalty beyond 2017 and increasing the amount to a maximum of 5 percent if fewer than 75 percent of physicians are using EHRs.)

Friday Jun 04, 2010

Red Flags rule deadline delayed ... again

The Federal Trade Commission (FTC) has announced that it will again delay enforcement of the identity theft Red Flags rule that was scheduled to take effect June 1. The new deadline is Dec. 31.

According to the FTC's press release, the request for the delay came from members of Congress who wanted more time to consider how entities covered by the rule would be affected.

This is the third time the deadline has changed. The original deadline was Aug. 1, 2009.

Wednesday Jun 02, 2010

Once more, the Senate leaves you with the bill

Or should I say, once more, the Senate leaves you with no bill. On Friday the House of Representatives had voted to keep the axe from falling until January 1, 2012, and had even voted you a raise of 2.2 percent for the rest of 2010 and a further 1 percent for 2011. But the Senate's response was just to go on vacation – Congress's one-week Memorial Day break. So you're once more making 21.3 percent less. Well, technically, you're not getting paid at all, but that's because the Centers for Medicare & Medicaid Services (CMS) have asked carriers to hold payments for 10 days or so to give the Senate time to settle down after vacation and consider the bill. No, it's not déja vu; it's happening again.

But would you want the bill to pass anyway? It wouldn't fix the Sustainable Growth Rate (SGR) formula; it wouldn't even hold things together for very long, and if it did pass, the SGR formula would just kick in again January 1, 2012. Worse, by then it would call for much steeper cuts.

The AAFP, at least, has had almost enough of congressional efforts to avoid decisive action on the SGR. It has laid out criteria by which to judge future patches to the formula. Basically, it will oppose any that expire before the end of 2012 and any that don't include some provision for paying extra for primary care. For now, though, it seems unlikely that Congress will be able to pass any patch that meets the Academy criteria. To get enough votes to pass the bill the House did pass last week, House leadership had to scale it back from a three-year bill that would apparently have met the new AAFP criteria to a two-year bill that does not.

The whole process is beginning to seem like Russian roulette, with the gun pointed at your head. Every time an SGR patch runs out, Congress decides, "What the heck, let's spin the cylinder one more time." I'm guessing that the hammer will come down on an empty chamber this time too – that the Senate and the House will agree on some relatively unpalatable short-term patch that will at least postpone the cut until after the elections. Maybe by then, Congress will have found the courage to make meaningful changes in the whole Medicare payment mess.

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