The current Sustainable Growth Rate (SGR) formula patch and therapy cap exceptions process expired on March 31. During the last week of March, the House of Representatives passed H.R. 2, a bill that would permanently repeal that formula, which many claim is flawed, but the Senate adjourned for its April recess on March 27 without voting on the bill. Therefore, the Centers for Medicare and Medicaid Services are now allowed to hold Medicare claims for physician services up to 10 business days.
When Congress returns from its two-week recess on April 13, the Senate will have one day to deal with the SGR, before CMS will have to resort to holding claims. CMS has reminded providers that, under current law, electronic claims are not paid sooner than 14 calendar days after the date of receipt (29 days for paper claims). CMS will notify providers on or before April 11, regarding what next steps CMS will take.
Senate leaders have indicated they plan to vote on permanent repeal when they return. We must keep the pressure on the Senate to pass the SGR repeal and replacement bill so that they know how necessary and important this bill is to all of us!
The bill would add about $200 billion to the projected Medicare budget over the next 10 years. It would include replacing the SGR with an increase of 0.5% in Medicare physician reimbursement starting in July 2015 through December 2015, and then annual 0.5% increases lasting through 2019.
The measure would also consolidate various reporting programs, such as the Meaningful Use program for electronic health records and several quality reporting programs, into a new merit-based incentive payment system and would incentivize physicians to participate in alternative payment models such as accountable care organizations (ACOs).
The bill also would extend the Children's Health Insurance Program as well as funding for community health centers and the National Health Service Corps.
House leaders are optimistic about the bill, which in the words of House Minority Leader Nancy Pelosi would “replace the broken SGR formula and transition Medicare away from a volume-based system toward one that rewards value, ensures the accuracy of payments, and improves the quality of care."
The fix has also been endorsed by many medical groups including the American Medical Association and the Association of American Medical Colleges. Now add your voice, by contacting your senator – in Ohio, Sherrod Brown by email or by phoning (202) 224-2315; Rob Portman, by email or by phoning 202-224-3353; in Pennsylvania, Robert Casey Jr. by email or by phone, 202.224.6324 or Pat Toomey by email or by phone, (202) 224-4254.
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Blue Sky Therapy has a continued commitment to patient-driven quality, excellence, integrity and innovation in everything that we do. That’s why we are scrupulous about planning the treatment of each and every client, and carefully documenting the outcome!