Posts Tagged SGR

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Medicare News This Week: The 27.5% Cut, Meaningful Use Stage 2 Specifications, and Upcoming Webinars

This Week’s Medicare News for Medical Practice Managers

Posted in: Day-to-Day Operations, Electronic Medical Records, Finance, Headlines, Medicare & Reimbursement, Medicare This Week

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CMS Will Hold January Claims for 10 Business Days in Hopes That the SGR Cut Will Be Delayed Before Payouts Begin

Everyone knows what a mess we’ve had in the past when CMS has had to pay according to the SGR, then it was reversed at the last minute and CMS had to pay additional amounts on services they had considered paid in full – a headache no matter how good your software is.

To avoid that, CMS will hold any claims for 10 business days before re-evaluating based on any change in the Medicare fee schedule for 2012. This will not actually hold anyone’s payments, as Medicare pays their claims in 14 days.

CMS made the following announcement today:

(more…)

Posted in: Headlines, Medicare & Reimbursement

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Texas Medical Association Video: Grandma and the Big Bad SGR

I haven’t written much about the impending 29% Medicare physician payment cut. This threatened cut has happened every year for the past 10 years. Every year at the last second, Washington is convinced that if cuts take place, physicians really will stop seeing Medicare patients and they halt the cut.

It’s not a bluff. Physicians can’t afford to see Medicare patients, TriCare (ex-military) patients and disabled patients with Medicare benefits now, and they will drop out by the tens of thousands if they get paid any less. Any businessperson worth their salt will tell you that when revenue does not exceed expenses, you do not have a sustainable business model. Physician have cut expenses to the bone, taken deep cuts in their salaries and ultimately have sold their practices when they just can’t make it anymore.

But never mind the doctor, what about the patients? What happens to them when physicians stop seeing Medicare patients? Texas Medical Association has made an outstanding video that explains it in language we can all understand.

 

 

Other organizations that are working to eliminate physician reimbursement being tied to the SGR are MGMA and the AMA.

Posted in: Headlines, Medicare & Reimbursement

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White Coat Wednesday: Call Congress November 17th to Protest the Medicare Physician Cuts

My lab coat and scrubs -- Samir धर्म 11:07, 7 ...

Please call the AMA Grassroots Hotline, and have everyone in your office/department/building/campus call the Hotline on Wednesday, November 17th (White Coat Wednesday) and every day thereafter until November 30th to insist that Congress vote for the 13-month patch to the SGR formula.

AMA’s toll-free Grassroots Hotline – 1.800.833.6354


AMA website discussing the issues here.

AMA flyer to post in your office here.

Posted in: Finance, Headlines, Medicare & Reimbursement

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A Perfect Day in Your Medical Practice: The Efficient and Well-Run Medical Office

Toilet paper

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  • All available appointments are full.
  • All staff showed up for their shifts.
  • No one burns toast in the toaster oven and sets off the fire alarm.
  • None of the staff show up to work wearing flip-flops or pink underwear beneath their white scrubs.
  • All patients have been reminded about their appointments so they all show up.
  • Patients calling for same-day appointments are able to be worked-in appropriately.
  • No patients give false information at check-in.
  • Established patients arrive on time with their insurance information and co-pay.
  • New patients arrive on time to complete their paperwork, and give their insurance card, photo ID and co-pay to the receptionist.
  • Patients with x-rays or other imaging studies bring the films or a CD.
  • Patients with fasting appointments arrive having fasted.
  • All patients arrive bringing their bag of medications.
  • Patients in wheelchairs and with difficulty ambulating are accompanied by caregivers.
  • Patients who do not speak English or are deaf have notified the office prior to the appointment and the appropriate technology or interpreters are available for the appointment.
  • Patients with procedure appointments have followed their pre-procedure instructions.
  • Patients with procedures have been pre-authorized by their insurance carrier and their personal financial responsibility has been discussed with them and payment arrangements have been made.
  • Patient eligibility has been checked and those unable to be authorized have been called before their appointment to gain further information about their payer source.
  • If computers go down, there are paper procedures in place to enable staff to continue seeing patients.
  • No patients arrive saying “I forgot to tell you, this is Worker’s Comp/ an auto accident/ a liability case and I was told by my lawyer not to pay anything.”
  • None of the patients pee on a waiting room chair.
  • Neither JCAHO nor any state or federal officers show up.
  • The copiers and faxes all work.
  • No subpoenas come in the mail.
    Letter Carrier Delivering Mail
    Image by Smithsonian Institution via Flickr
  • It’s not your very first day live on electronic medical records.
  • All phone calls are answered before the third ring and no one has to leave a message.
  • No patients walk in the door with severe chest pains and say “I knew the doctor would want to see me.”
  • Patients remember to call the pharmacy for refills.
  • Providers all run on time and seem in particularly good moods.
  • Patients get their questions answered with callbacks within two hours.
  • Someone delivers sandwiches, drinks and brownies to the practice for lunch.  There is enough for everyone.
  • No bounced checks come in the mail.
  • Providers spend so much time in the exam room listening to their patients that the patients leave feeling that every question they had (and a few they didn’t know they had) was answered.
  • Providers circle the services and write the diagnosis codes numerically on the encounter form, remembering that Medicare doesn’t pay for consults any more.
  • Sample medications that providers want to give patients are in the sample closet.
  • Records that providers want to reference are in the chart and are highlighted.
  • No one calls urgently for old medical records that are in the storage unit across town.
  • There are no duplicate medical records.
  • Patients checking out never say “But he was only in the room for 5 minutes!”
  • The patient restrooms don’t run out of toilet paper.
  • No bankruptcy notices come in the mail.
  • All phlebotomists get blood on the first stick.
  • No kids cry.
  • The HVAC system works beautifully, keeping it cool where it needs to be cool, and warm where it needs to be warm.
  • Congress announces that the SGR formula has been revoked and a new reasonable model for paying physicians has been discovered.
  • Everyone goes home at 5:00 p.m., glad to have a job, glad to be of service, and happy with their paychecks.

Posted in: A Career in Practice Management, Day-to-Day Operations

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91 Physician Organizations Sign Statement Naming Congress in “Mismanagement of the Medicare Program” and Imploring it to “Honor its Obligation”

UPDATE: On June 25, 2010, President Obama signed into law the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 (H.R. 3962)” which includes a delay in the 21+% Medicare fee cut until November 30, 2010. CMS will have the MACs start processing new claims with dates of service of June 1, 2010 and later at the 2009 fee schedule plus a 2.2% increase.  The MACs will also have to reprocess the claims already paid for dates of service June 1, 2010 and later that were processed with 2010 fee schedule and that big fat cut.

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Note: On June 16, 2010 the Senate failed to pass a proposal that would increase the Medicare reimbursement for physicians by 2.2% for the balance of calendar year 2010 and by 1% for calendar year 2011.   Senate leadership is now working on a plan to extend the freeze until year-end.  The following statement was released by the state medical societies of all 50 states and the District of Columbia, as well as 41 specialty physician organizations.

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Statement of the State and Specialty Medical Societies on the Medicare Physician Payment Crisis

Failure by Congress to fulfill its responsibilities is undermining patient care in America.  Three times this year, Congress has missed a deadline for dealing with Medicare’s sustainable growth rate (SGR) formula, raising the specter of a 21 percent payment cut for physician services.  The disruption and uncertainty for patients and physicians has made Medicare an unreliable program.

If Congress does not act this week, Medicare physician payments will be cut 21 percent.  These cuts will also extend to the TRICARE program which serves military families, as well as some Medicaid programs, workers compensation programs and private insurance plans.  The ripple effect of the 21 percent Medicare cut will be devastating to physician practices.

Congressional mismanagement of the Medicare program will force more physicians to stop accepting new Medicare and TRICARE patients; lay-off staff; and defer investment in new medical equipment, health information technology, and other innovations that improve patient care.

Patients and physicians should not become collateral damage in a Congressional stalemate on budgetary matters.  We expect our elected officials to resolve the budget issues without punishing physicians, seniors and military families.

Past actions by Congress created the current budgetary challenge.  Further, since 2003, Congress has compounded this problem by employing budget gimmicks that defer immediate cuts by stipulating deeper cuts in future years.

Democrats and Republicans agree that the flawed Medicare formula that is responsible for pending cuts should be repealed.  The annual SGR battle diverts attention from more productive delivery and payment reform initiatives.  We must move to a payment system that fosters innovation and rewards physician efforts to lower the rate of growth in Medicare spending across the existing silos in the program.

Medicare must adequately cover the cost of care and close an existing 20 percent gap as measured by the government’s own conservative measure of annual increases in medical practice costs.

We must also allow seniors who wish to contract directly for their care with a physician of their choice to do so without foregoing the Medicare benefits for which they paid during their working years.  Medicare benefits were earned by and belong to Medicare beneficiaries.  They must be allowed to assign these benefits as they see fit.

Playing brinksmanship with the health care of seniors and military families is inexcusable and represents a dereliction of duty.  We urge Congress to honor its obligation to provide access to quality care to America’s seniors and military families by taking action to fix the Medicare physician formula problem now!

American Academy of Dermatology
American Academy of Facial Plastic & Reconstructive Surgery
American Academy of Family Physicians
American Academy of Hospice & Palliative Medicine
American Academy of Neurology
American Academy of Ophthalmology
American Academy of Pain Medicine
American Academy of Pediatrics
American Academy of Physical Medicine & Rehabilitation
American Academy of Sleep Medicine
American Association for Hand Surgery
American Association of Clinical Endocrinologist
American Association of Clinical Urologist
American Association of Neurological Surgeons
American Association of Neuromuscular & Electrodiagnostic Medicine
American Association of Public Health Physicians
American College of Cardiology
American College of Emergency Physicians
America College of Gastroenterology
American College of Obstetricians & Gynecologists
American College of Occupational & Environmental Medicine
American College of Rheumatology
American College of Surgeons
American Gastroenterological Association
American Institute of Ultrasound in Medicine
American Medical Association
American Orthopaedic Foot & Ankle Society
American Society for Clinical Pathology
American Society for Reproductive Medicine
American Society for Surgery of the Hand
American Society of Addiction Medicine
American Society of Cataract & Refractive Surgery
American Society of Cytopathology
American Society of Ophthalmic Plastic & Reconstructive Surgery
College of American Pathologists
Congress of Neurological Surgeons
Heart Rhythm Society
North American Spine Society
Renal Physicians Association
Society of American Gastrointestinal Endoscopic Surgeons
Society of Nuclear Medicine

Medical Association of the State of Alabama
Alaska State Medical Association
Arizona Medical Association
Arkansas Medical Society
California Medical Association
Colorado Medical Society
Connecticut State Medical Society
Medical Society of Delaware
Medical Society of the District of Columbia
Florida Medical Association, Inc.
Medical Association of Georgia
Hawaii Medical Association
Idaho Medical Association
Illinois State Medical Society
Indiana State Medical Association
Iowa Medical Society
Kansas Medical Society
Kentucky Medical Association
Louisiana State Medical Society
Maine Medical Association
MedChi, The Maryland State Medical Society
Massachusetts Medical Society
Michigan State Medical Society
Minnesota Medical Association
Mississippi State Medical Association
Missouri State Medical Association
Montana Medical Association
Nebraska Medical Association
Nevada State Medical Association
New Hampshire Medical Society
Medical Society of New Jersey
New Mexico Medical Society
Medical Society of the State of New York
North Carolina Medical Society
North Dakota Medical Association
Ohio State Medical Association
Oklahoma State Medical Association
Oregon Medical Association
Pennsylvania Medical Society
Rhode Island Medical Society
South Carolina Medical Association
South Dakota State Medical Association
Tennessee Medical Association
Texas Medical Association
Utah Medical Association
Vermont  Medical Society
Medical Society of Virginia
Washington State Medical Association
West Virginia State Medical Association
Wisconsin Medical Society
Wyoming Medical Society

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CMS Delays Claim Payment Until June17th, Hoping for Congress Movement to Further Delay or Repeal (?) the SGR Formula

Still life - Crazy doctor

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UPDATE: On June 24, 2010 the House and Senate passed legislation to further delay the Medicare cuts until November 30, 2010. More here.

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Excerpt From Today’s CMS Announcement (with my bolding):

The Centers for Medicare & Medicaid Services (CMS) is hopeful that Congressional action will be taken within the next several days to avert the negative update.

Given the possibility of Congressional action in the very near future, CMS is now directing its contractors to continue holding June 1 and later claims through Thursday, June 17, lifting the hold on Friday, June 18.

This action will facilitate accurate claims processing at the outset and minimize the need for claims reprocessing if Congressional action changes the negative update.  It also should minimize the provider and beneficiary burdens and costs associated with reprocessing claims.

We understand that the delayed processing of Medicare claims may present cash flow problems for some Medicare providers.  However, we expect that the delay, if any, beyond the normal processing period will be only a few days.  Be on the alert for more information regarding the 2010 Medicare Physician Fee Schedule Update.

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Congress Expected to Further Delay SGR Cut to Medicare Physician Fee Schedule

UPDATE: On June 24, 2010 the House and Senate passed legislation to further delay the Medicare cuts until November 30, 2010. More here.

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Congress has yet to pass a bill delaying the June 1, 2010 21.2% reduction in physician reimbursement, but most believe it will happen and be effective retroactively.

CMS has said it is anticipating a further delay in Medicare fee schedule cuts, so they have “instructed contractors to hold claims containing services paid under the MPFS for the first 10 business days of June.”

More information on my post here.

Stay tuned!

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Medicare Cuts Delayed Again, This Time Until June 1, 2010

UPDATE: On June 24, 2010 the House and Senate passed legislation to further delay the Medicare cuts until November 30, 2010. More here.

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Close on the heels of an affirmative Senate vote, the House of Representatives approved HR 4851 (Continuing Extension Act of 2010) which once more delays, albeit temporarily, the mandated 21.2% physician fee cuts tied to the SGR.  The bill now goes to the President to be signed.

What is the SGR? The Sustainable Growth Rate is a general marker of inflation. In 1998, due to concerns of rapidly escalating healthcare costs, Medicare payments for physicians were permanently tied to the SGR.  As healthcare inflation has outstripped general inflation since 2002, the cost of physician services has exceeded the predicted SGR. Every year since then, a predicted cut in Medicare physician fees has been bitterly fought, a temporary fix has been passed and the cumulative effect grows.

Many physician organizations are lobbying for the permanent repeal of tying Medicare rates to the SGR, but there are varying opinions on what would take its place and what it would cost to make the change.

Here is the recent history of the Medicare physician fees by year, the proposed cuts and the actual change in physician fees:

2002 -5.4% cut proposed  – None made
2003 -4.4% cut proposed – 1.6% increase given
2004 -4.5% cut  proposed – 1.5% increase given
2005 -3.3% cut  proposed – 1.5% increase given
2006 -4.4% cut proposed – Freeze at 2005 level
2007 -5% cut  proposed- Freeze at 2005 level
2008 -10.1% cut proposed –  0.5% increase given
2009 -15% cut  proposed – 1.1% increase given
2010 -21% cut  – ??????

Hopefully, no Medicare claims have actually been paid at the 2010 level, although it was reported that the system with new rates in place was being thoroughly “tested” today.  If no checks went out with 2010 reimbursement and no “makeup” checks are generated, I suspect more than just a few of the taxpayers’ dollars will have been saved.

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