Medicare:
NEWS:
Emerging Compromise on Medicare SGR Formula for Physician Payments
Thursday, February 16, the House and Senate conferees reached agreement on an extension of a 2 percent reduction in Social Security payroll taxes. The package now includes an extension of the current postponement of a nearly 30% reduction in Medicare's Sustainable Growth Rate (SGR) formula for another 10 months, until the end of calendar year 2012. This is welcome news, since the current SGR postponement lasts only until the end of February, and Congress must approve and the President must sign legislation to avoid the cuts that would otherwise automatically occur on March 1, 2012.
Not all of the news is good, however. The decision to simply postpone the SGR cuts for another 10 months does nothing to permanently address the SGR formula itself. This means that the price tag for a permanent "fix" will continue to grow. Meanwhile, Congress will again have to address the cut that will otherwise take place automatically on January 1, 2013.
Based on preliminary information, the SGR postponement is paid for by: · Reducing the Public Health and Prevention Fund created under health reform by $5 billion/10 years;
· Reducing hospital Disproportionate Share (DSH) adjustments by $4 billion/10 years;
· Reducing hospital bad debt payments by $6.8 billion/10 years; and;
· Adjusting federal employees' pension payments.
We have also been advised that the package does not continue the temporary 5% "bump" for Medicare psychotherapy services, although we do not have final confirmation of this policy development. You will recall that the bump, which was extended several times over the past four years, was never intended to be permanent payment policy.
Our understanding is that the SGR/payroll tax package will be voted on by the House and Senate as early as tomorrow. DGR will provide additional information as it becomes available.
2012 Medicare Claims Should be Held Until January 18 [posted 01/05/2012]
Because Congress acted so late in 2011 to override the 27.4% cut in Medicare fees demanded by the Sustainable Growth Rate (SGR), Medicare contractors may not have their files ready to process claims at the correct fee rate until January 18. However, it is expected they will all have the correct fee schedule posted on their websites by January 11 (currently most of them have the fees in place from before Congress acted to override the cut). For nonparticipating providers, who bill their patients up-front for the entire fee, if you cannot wait until the new fees are posted, using the 2011 fee schedule may amount to a slight over- or undercharge that can be corrected in the future when the actual fees are posted.
Note: Congress provided for only a two-month fix; in March they will either issue a continuance of the temporary rate or provide a new fee schedule. The APA will provide an update here as soon as we have the information.
Read More... http://www.psych.org/MainMenu/PsychiatricPractice/MedicareMedicaid.aspx
APA News - December 23, 2011 - House and Senate Pass Compromised “Extenders” Bill
Both the House and Senate approved, by unanimous consent, a compromise two-month extension of expiring provisions—including a postponement of the 27% Medicare “SGR” payment reduction scheduled for January 1, 2012. Congress will now have time to work out a long-term postponement or fix of the SGR problem. While less than ideal, congressional action means that APA members should not see any reductions in their Medicare payment rate on January 1.
We welcome this action, and will continue to work for a permanent fix to the SGR.As always please feel free to contact us advocacy@psych.org if you have any questions.
