Medicare

Medicare Rates for 2013: Implications for Practices

Posted in Medicare on January 7th, 2013 by MMS – Comments Off on Medicare Rates for 2013: Implications for Practices

Updated Jan. 15, 2013

Following action by Congress on Dec. 31 and Jan. 1, all services for Medicare patients provided after Jan. 1, 2013 will be reimbursed at 2012 rates.

However, the CMS fee schedule – as of today – still reflects the planned 27% cut, and CMS has not yet updated the schedule. By law, Medicare is required to pay physicians the lesser of the submitted charge or the Medicare approved amount, so the AMA is advising physicians not to submit claims until CMS revises the fee schedule to reflect the 2012 rates. These revisions are expected shortly.

[Update: The CMS contractor for New England has told us that the 2013 fee schedule has been updated, and reflects 2012 rates. The advice in the paragraph above is no longer valid.]

Also, because of the uncertainty over payment rates, CMS has given physicians until Feb. 15 to decide whether they want to change their Medicare participation status for the 2013 calendar year. If you choose to change your participation status, the effective date would be retroactive to Jan. 1, 2013.

Review the issues unique to Massachusetts physicians, and download instruction on how to change your status.

House Vote Blocks Medicare Payment Cut For One More Year

Posted in Medicare on January 1st, 2013 by MMS – Comments Off on House Vote Blocks Medicare Payment Cut For One More Year

Once again displaying the brinkmanship that was its hallmark, the 112th Congress finally passed legislation Tuesday night to avert the “fiscal cliff” for at least two more months, and blocked a devastating 27 percent cut in physician Medicare fees for at least another year.

The Senate overwhelmingly (89-8) passed a compromise brokered by Vice President Biden and Senate Minority Leader McConnell at 2 a.m. on New Year’s Day. The House followed suit precisely 21 hours later, passing the measure 257-167.

But that comfortable margin belies the fact that for several hours on New Years’ Day, the bill seemed doomed. Republican leaders, unhappy over what they said were insufficient spending cuts, were threatening to amend the bill and send it back to the Senate to a certain death. But after determining that this tactic might not even pass their own chamber, they scheduled a straight up or down vote for the end of the evening, with no amendments.

The Medicare patch was paid for by cutting spending in other Medicare accounts. These cuts included:

  • $10.5 billion by adjusting some hospital coding rules
  • $4.9 billion in payments for end-stage renal disease care
  • $4.2 billion in payments to Disproportionate Share Hospitals (DSH)

Full details of the Medicare extensions and cuts are available here.

Here’s the AMA’s statement on the vote:

This patch temporarily alleviates the problem, but Congress’ work is not complete; it has simply delayed this massive, unsustainable cut for one year. Over the next months, it must act to eliminate this ongoing problem once and for all.

This last-minute action on the part of Congress is a clear example of how the Medicare program is increasingly unreliable for physicians and patients. This instability stalls progress in moving Medicare toward new health care delivery models that can improve value for patients through better care coordination.

Physicians want to work with Congress to move past this ongoing crisis and toward a Medicare program that ensures access to care and the best health outcomes for patients and a stable, rewarding practice environment for physicians.

Senate Bill Would Block Medicare Payment Cut

Posted in Medicare on January 1st, 2013 by MMS – 1 Comment

Updated Jan 1 9:00 p.m.

Early this morning, the U.S. Senate approved “fiscal cliff” bill that includes a postponement of the 27% cut in physicians’ Medicare fees for one year. If the House passes the measure, fees would be frozen at current rates throughout 2013.

The move was paid for by cuts elsewhere in the federal government’s health care budget., but the details of those cuts aren’t clear as of this writing.

According to Modern Healthcare, the cost of the freeze will be borne principally by hospitals. For example, the bill would adjust some coding rules cutting $10.5 billion in hospital payments; cut $4.9 billion in payments for end-stage renal disease care; and cut  Disproportionate Share Hospital (DSH) payments by $4.2 billion.

House Republicans decided to put the measure to a full vote late Tuesday night, after several hours of threats to amend the bill. That action would effectively kill its prospects for this session of Congress, because Senate leaders have flatly declared  they will not consider an amended bill.

It’s now up to the House to act, but late Monday, Republican leaders weren’t making any promises about what would happen on New Years’ Day. 

We’re following the events in Washington and will provide updates as they become available.

AMA to Physicians: Prepare for the Worst

Posted in Medicare on December 19th, 2012 by MMS – 4 Comments

The American Medical Association today told physicians to start preparing for a 27% cut in Medicare payment rates, after concluding that the deficit talks on Capitol Hill are “at an impasse.”

The AMA wrote, “We feel compelled to advise physicians to start making plans for steps they can take to mitigate this disruption and meet their own financial obligations in January, in case the 26.5 percent cut actually takes effect. ”

The AMA continued, “Given the potential impact on practice revenue in early January, physicians should be certain adequate arrangements are in place to sustain their practices.  For those physicians who are forced into the untenable position of limiting their involvement with the Medicare program because it threatens the viability of their practices, we urge that patients be notified promptly so that they, too, can explore other options to seek health care and medical treatment.”

The Administration has announced that if the cuts go through, the Centers for Medicare and Medicaid Services will follow normal claims processing procedures.  That is, claims will not be held and Medicare carriers will process payments for physician services provided after December 31 under the normal 14-day cycle required by law.  Payment for these claims would be based on the new, lower fee schedule conversion factor of $25.0008, as opposed to the current rate of $34.0376.

The AMA continues to urge Congress to block the cut and enact for a permanent replacement for the SGR. In a message today, the AMA called the failure of Congress to address the situation “inexcusable.”

It said, “This continuing game of political chicken is unacceptable and dangerous to the future of the Medicare program.”

The Massachusetts delegation has had a strong record of support for the MMS objective of replacing the current Medicare payment formula with a permanent, rational and sustainable new payment system.

Last week, MMS President Richard V. Aghababian, MD, wrote the Massachusetts delegation, saying,  “There is no question that cuts of this magnitude would erode access to health care as well as the medical and health care community in this region.”

Physician Groups Disappointed by Temporary Medicare Rate Patch

Posted in Medicare on February 15th, 2012 by Erica Noonan – Comments Off on Physician Groups Disappointed by Temporary Medicare Rate Patch

Physician groups expressed disappointment today over a House and Senate conference committee proposal that would delay by 10 months, but not permanently fix, a scheduled 27.4 percent cut to Medicare physician rates.

The $20 billion Congressional plan – which would also extend the payroll tax holiday and unemployment insurance benefits through the end of 2012 – would be paid for with public health funding from the federal Affordable Care Act and cuts to federal health-care and Medicaid spending, including programs for hospitals with bad debt, officials said.

A previous two-month delay to the Medicare cuts, hammered out in a dramatic year-end Congressional session, was set to expire March 1.

Late last month, the MMS, the AMA and 107 other state and specialty medical societies called on Congress to eliminate the payment formula permanently, and offsetting the costs with money budgeted, but not utilized, during the Iraq and Afghanistan wars.

MMS president Lynda Young said today she was frustrated that lawmakers did not come up with a permanent solution, and settled for yet another short-term patch.

A true solution — a full and complete repeal of the Medicare payment formula – is long overdue,” said Dr. Young.  “We deeply appreciate the fact that the Massachusetts congressional delegation has supported reforming the payment formula and hope to work with them in the coming months to achieve this goal.”

AMA president Peter Carmel, MD, called the conferees’ action “a serious missed opportunity to permanently replace the flawed Medicare physician payment formula and protect access to care for military families and seniors.”

“People outside of Washington question the logic of spending nearly $20 billion to postpone one cut for a higher cut next year, while increasing the cost of a permanent solution by about another $25 billion,” Carmel said.

House Speaker John Boehner said he expects the tentative agreement could be voted on by the House and Senate by week’s end.

–Erica Noonan

Think Medicare Payments Aren’t Changing? Think Again

Posted in Medicare on January 5th, 2012 by MMS – Comments Off on Think Medicare Payments Aren’t Changing? Think Again

The AMA reminded physicians yesterday that even though the 27 percent cut in Medicare payments has been blocked for two months, there are still changes coming to some Medicare fees.

Here’s what the AMA said:

The payroll tax extension legislation that was passed by Congress and signed by the President on Dec. 23, 2011 (Public Law 112-078) delayed the 27.4% Medicare pay cut due to the SGR formula for two months. It also extended the floor on the work geographic practice cost index (GPCI) and certain other policies.

The Centers for Medicare & Medicaid Services (CMS) has confirmed to the AMA, however, that all of the other changes that were included in the Medicare physician payment final rule for 2012 will still take effect.  Physicians should not expect that payment rates will remain unchanged.

As detailed in a memo sent to the Federation on Nov. 4, 2011 following release of the final rule, numerous changes are being made in the relative value units, GPCIs, electronic prescribing and quality reporting programs, and multiple procedure payment rules for 2012.  All of these changes will take effect as scheduled for dates of service beginning Jan. 1, 2012.

In addition, although P.L. 112-078 provided for a zero percent update to the Medicare conversion factor, the final rule indicated that there would be a 0.18% increase in the conversion factor for budget neutrality and this change will also be effective Jan. 1, 2012.  The budget neutrality increase is due to CMS adoption of the RVS Update Committee recommendations for misvalued codes.  The 2011 conversion factor was $33.9764.  The 2012 conversion factor will be $34.0376.

CMS also has indicated that because Congress acted so late in 2011 to prevent the SGR cut, claims must still be held for a period of time to allow CMS time to develop the new payment rate files and the Medicare claims administration contractors time to install and test the files.  CMS expects that most if not all contractors will be ready to process claims under the revised rates on or before Jan. 18, 2012, which is the end of the 10-business-day claims hold period previously announced, but contractors’ time frames may differ.  Contractors are expected to have the new rates posted to their web sites by Jan. 11.

Finally, CMS published in the Jan. 4, 2012, Federal Register a correction notice to the 2012 final rule that modifies the relative values for a number of services.  The agency also posted to its web site a revised relative value file reflecting both the corrections and the legislation that stopped the 27.4% cut.

Got that?

It’s Official: Congress Freezes Medicare Payments for Two Months

Posted in Medicare on December 23rd, 2011 by MMS – Comments Off on It’s Official: Congress Freezes Medicare Payments for Two Months

Under enormous political pressure inside and outside its ranks, House Republicans Friday morning reversed themselves and passed a two-month freeze of the 27 percent cut in Medicare physician fees. The Senate followed suit. The vote also extended a payroll tax cut and long-term unemployment benefits. President Obama signed the bill a few hours later.

In return, Democrats appointed members to a conference committee that will go to work in early January to design a one-year freeze of the SGR formula. As Senate Major Leader Harry Reid said, “Two months is not a long time.”

At his news conference on Thursday, House Speaker John Boehner was still expressing home that the long-term fix would be for two years.

The AMA again urged Congress to end “this sorry cycle of scheduled cuts and short-term patches” and provide long-term stability for Medicare and its patients.

The votes – both by unanimous consent – came after a wild 10-day period:

  • First, the  House passed a one-year freeze that was unacceptable to Senate Democrats.
  • Then, last weekend, the Senate passed a two-month freeze, with the apparent blessing of House Republican leaders.
  • But GOP rank and file rebelled the next day, and forced the House to reject the Senate deal, and demand more negotiations.
  • The House’s decision to reverse its course surfaced suddenly at mid-afternoon on Thursday; by 5:00 p.m. the two-month deal was announced. It’s almost identical to the bill the House rejected on Tuesday.

Want to learn more?

In Shift, House Now Agrees to Two-Month SGR Fix

Posted in Medicare on December 22nd, 2011 by MMS – Comments Off on In Shift, House Now Agrees to Two-Month SGR Fix

UPDATED: 6:17 p.m.

That two-month freeze of physician Medicare rates has returned from the dead.

Late this afternoon, House Speaker John Boehner announced that the House will pass a two-month freeze of the pending 27% Medicare pay cut “before Christmas,” along with extensions of the payroll tax and unemployment benefits.

Barring another last-minute surprise, the vote is expected to come Friday morning on motions for unanimous consent in each chamber.

In return, Senate Major Leader Harry Reid agreed to appoint Democrats to a conference committee that will get to work early in January to negotiate a longer freeze. As Reid noted, “Two months is not a long time.”

We’ll watch the proceedings Friday morning and keep you updated.

House Rebuffs Senate; 27% Medicare Payment Cut Likely

Posted in Medicare on December 20th, 2011 by MMS – Comments Off on House Rebuffs Senate; 27% Medicare Payment Cut Likely

In a bitter, emotional vote today, the U.S. House rejected a Senate bill that would have blocked the 27 percent Medicare reimbursement cut scheduled to take effect on Jan. 1. The bill would have also extended a payroll tax cut and extended unemployment benefits for the same two-month period.

The House called on senators to return to Washington and negotiate their differences in a conference committee, but Democratic leaders in the Senate say they’re done for the calendar year, and won’t return until next month. Clearly, each party is gambling that the other will shoulder the blame for the breakdown.

MMS President Lynda Young MD, said, “We’re very disappointed that Congress has failed to act. Today’s vote seriously destabilizes Medicare, and causes anxiety for physicians and seniors who depend on it. The true solution — a full and complete repeal of the Medicare payment formula – is long overdue.

“We also deeply appreciate the fact the entire Massachusetts congressional delegation has supported reforming the payment formula. We look forward to working with them to achieve this goal.”

In a statement this afternoon, the AARP said, “Our members have a clear message for Congress: don’t cut our doctors’ Medicare payments.”

What about physicians? Barring a holiday miracle, the 27 percent cut will take effect on January 1, putting a severe crimp on practices’ finances. The Centers for Medicare and Medicaid Services said yesterday that its contractors won’t process any claims for January services until January 17, in the hope that Congress can pull something together. (This processing delay is part of the contractors’ normal business practice.)  If there’s no action from Congress, claims will be paid at the lower rate.

We’ll pass along more information as we get it. Check the MMS website’s Medicare page for any updates. Our Twitter feed will also post updates.

Senate Approves Two-Month Freeze of Medicare Fees

Posted in Medicare on December 17th, 2011 by MMS – Comments Off on Senate Approves Two-Month Freeze of Medicare Fees

By a lopsided 89-10 vote, the Senate approved a bill on Saturday morning that would freeze physicians’ Medicare fees at current levels for two months, temporarily averting a devastating 27% cut.

UPDATE: House Speaker John Boehner said Sunday that the House will probably reject this bill, and send it to conference committee for further negotiation. That would make a resolution of the matter before the New Year quite dim.

In addition to the Medicare provision, the bill extends a payroll tax holiday and extends long-term unemployment benefits for the same two-month period.

One big dispute, the construction of an oil pipeline between Canada and Texas, was resolved when Democrats dropped their opposition, in return for Republicans accepting the payroll tax and unemployment extensions.

The AMA responded with a renewed call for a permanent reform of the Medicare payment formula.

“It is time for Congress to act on previous commitments to repeal the failed Medicare physician payment formula,” said AMA President Peter Carmel, MD.

“The 12 temporary patches that Congress has applied have raised the cost of solving the problem by more than 500 percent over the last few years and eroded patients’ access to care. A permanent solution is the long overdue, fiscally responsible approach,” he said.

Read more about Medicare and the  SGR issue here.