Deborah C. Hall, New Product Subject Matter Expert
The Protecting Access to Medicare Act of 2014 has been passed by both the House of Representatives and the Senate and is expected to be signed by the president. This act maintains the current Medicare payment rates through March 2015, again delaying a permanent fix to the sustainable growth rate (SGR). It also delays implementation of ICD-10 for another year. With the passage of the bill, ICD-10 will not become effective until October 1, 2015.
The SGR is a formula used to update physician payment under the Medicare program and became law in 1997. Generally the SGR is used to prevent Medicare expenses from growing faster than that of the gross domestic product (GDP). The formula has caused cuts to physician reimbursement, however, and for this reason, Congress has voted to prevent the negative update 17 times. Physician groups, such as the American Medical Association, have been actively lobbying Congress to pass a “doc fix” that would prevent a negative update.
While waiting for Congress to act, the Centers for Medicare and Medicaid Services (CMS) instructed Medicare contractors to hold claims containing services paid under the Medicare physician fee schedule (MPFS) for 10 business days starting April 1. CMS indicates that the hold should have minimal impact on provider cash flow because, under current law, clean electronic claims are not paid any sooner than 14 calendar days and paper claims are not paid for 29 days after the date of receipt. All claims for services delivered on or before March 31, 2014, will be processed and paid under normal procedures, regardless of any congressional actions.
The 2014 MPFS final rule stipulated a negative update that was to be effective January 1, 2014. That reduction was averted for three months with the passage of the Pathway for SGR Reform Act of 2013, which provided for a 0.5 percent update for services paid under the MPFS through March 31, 2014.