Physicians will have at least another two weeks of lag time to account for processing before Medicare reimbursement cuts take place—or the SGR is repealed—according to the Centers for Medicare & Medicaid Services.
The 21% "negative update" in Medicare reimbursement for physicians mandated by the Sustainable Growth Rate funding formula goes into effect on Wednesday, but physicians will have another two weeks of lag time to account for processing before the cuts take place, according to the Centers for Medicare & Medicaid Services.
"The Administration urges Congress to take action to ensure these cuts do not take effect," CMS said this week in an advisory to physicians. "However, until that happens, CMS must take steps to implement the negative update. Under current law, electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt. CMS will notify you on or before April 11, 2015, with more information about the status of Congressional action to avert the negative update and next steps."
In the short term, CMS has used the processing delay previously to circumvent cuts mandated by a lapsed SGR deadline, which has allowed Congress to intervene and extend the temporary deadline, as it has done 17 times before.
That 14-day window pushes the drop-dead date for the SGR cuts back to April 14, which means that when the Senate reconvenes on April 13 it will have one day to debate the legislation and pass it.
"By law, no claim can be paid sooner than the 14 calendar days from [its] receipt," says Jennifer Pollack, government affairs representative for the Medical Group Management Association.
"CMS has instructed its carriers to hold any claims for 10 business days for services provided on April 1. That means they will be held through April 14. Hopefully, between the 14 calendar days and people holding a little bit, Congress will have time to come back and fix everything," Pollack says.
Despite grumbling from some Senators in both parties, the bill is expected to pass. It received strong bipartisan support in the House, which approved the $145 billion package on a 392−37 vote. President Obama has already said he will sign the bill.
"People are generally supportive. It's been something that's been a pain in the side for so long," Pollack says. "The Democrats in the Senate were hoping to have a little bit more of their wants included in this, with the CHIP extension for four years, and getting rid of the Hyde Amendment language. But, I would think and hope that they would understand that negotiations did take place and frankly this is the best deal we are going to get on all sides. I think they will all end up supporting it in the end."
Even if the Senate cannot act before April 14, Pollack says that doesn't necessarily mean that physicians will see their reimbursements slashed.
"CMS can't do it themselves, but in the bill Congress can say we are voting on this so the cuts won't happen on April 1. Say it is April 18, for example. What most likely happen is people will have to resubmit their claims. They won't get cut, but it is additional paperwork for CMS and the providers. It's a bit of an administrative burden, hence the urgency now."
John Commins is the news editor for HealthLeaders.