Health Information Management

Fate of "doc fix" bill remains unclear

HIM-HIPAA Insider, April 6, 2015

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Although the House overwhelmingly passed a bipartisan bill that would permanently fix the Sustainable Growth Rate (SGR) problem March 26, the bill’s future remains unclear as it lies in wait until the Senate returns from its recess April 13.

 
In the meantime, a 21% “negative update” in Medicare physician reimbursement became effective April 1. However, CMS has a two-week lag time for processing claims. The final date for the Senate to rule on the bill is April 14, according to HealthLeaders Media.
 
In an advisory, CMS instructed providers to hold claims with dates of service on or after April 1 for 10 business days. This means that by the time the claims are released, the Senate will have reconvened and likely will have made a determination about the future of the SGR, HealthLeaders Media reported.
 
The bill is designed to repeal the SGR and increase physician payments by 0.5% annually for the next four years, after which physicians would likely see annual payment increases of 0.25%. The bill includes a merit-based incentive payment system (MIPS) that awards bonuses or imposes penalties based on physicians’ composite performance scores. The MIPS would be applicable for services furnished on or after January 1, 2019.
 
In addition to addressing the SGR, the bill would extend the probe and educate audit period for the 2-midnight rule through September 30, 2015. Previously, the 2-midnight rule was limited to pre-payment reviews through March 30, 2015, unless was auditors found evidence of systematic gaming, fraud, abuse, or delays in the provision of care by a provider of services. In the meantime, CMS announced that it would extend the probe and educate audits through April 30, 2015.



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