June 18, 2010
SGR Update:
This week has been frustrating for any physician in the United States, and perhaps even worse for cardiologists trying to run small businesses. Congressional gridlock is at its best. That being said, the Senate this afternoon by unanimous consent passed a six-month patch that would give doctors a 2.2 percent payment update through November. The agreement will now go to the House, which has adjourned for the week and will not consider it until at the earliest Tuesday of next week.
On the CMS front, the claims hold expired yesterday (June 17). Because legislation was not signed into law before the weekend, contractors have been instructed to begin processing Medicare claims for physician services provided in June at rates that reflect the 21.3 percent cut. Once the House and Senate act to avert the cut, claims will be processed as follows: (1) where the submitted charge is higher than the new rate, the contractor will automatically reprocess the claim; and (2) if the submitted charge is lower than the new rate, the physician should call the contractor. According to the AMA, no one is going to be reviewing the limiting charge for the period that the cut was in place because CMS assumes Congress will ultimately make the fix retroactive.Finally, the OIG and CMS are close to releasing a document to waive patient co-pay requirements for situations such as the retroactive increases that were made to the geographic practice cost index (GPCI) increases. CMS will share that document once it is available.
Questions/Comments contact ACC Advocate Editor Steve Erickson at advocate@acc.org.
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