Medicare Payments at 21.5% Cut

Based upon the remaining announced schedule for the U.S. Senate, no action will be taken on enacting a fix (temporary or otherwise) to the SGR problem prior to June 14th . Beginning on June 14th, physicians should expect that Medicare Contractors will begin making payments for Part B claims for services provided on or after June 1 at the SGR reduced payment level.

The House and Senate continue to work on legislation providing an 18 - 24 month SGR fix but it will be impossible for them to complete action on that legislation and get a bill to the President prior to Monday, June 14th.

While we fully anticipate that Congress will eventually enact legislation restoring the full payments for all claims subject to the SGR cut, it is not clear exactly when that might occur. All Congressional action is currently focused on enacting an SGR fix that is at least 18 months long rather than the 30 or 60 days "fixes" that have become the norm this year. Once Congress enacts an SGR fix, it is also not clear whether providers will be asked to resubmit claims or whether Contractors will automatically reprocess the previously submitted claims and remit the additional payments to the providers with no additional action required by the provider to obtain full payment.

There is broad bi-partisan support for fixing the SGR problem in both the House and Senate, and various proposals for fixing the SGR problem have been put forward by Members of both parties. Unfortunately, there are significant policy differences over how to "pay for" the SGR fix as well as differences on just what the new policy should be that would replace the current Sustainable Growth Rate formula.

Med USA will continue to monitor this situation and keep you informed of the latest developments. If you have any questions please feel free to contact Liz Gardner at 801.352.9500 ext 1308 or email lgardner@medusabil.com