Health Information Management

Fate of "doc fix" bill remains unclear

HIM-HIPAA Insider, April 6, 2015

Want to receive articles like this one in your inbox? Subscribe to HIM-HIPAA Insider!

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.

Want to receive articles like this one in your inbox? Subscribe to HIM-HIPAA Insider!

    Briefings on APCs
  • Briefings on APCs

    Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...

  • HIM Briefings

    Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...

  • Briefings on Coding Compliance Strategies

    Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...

  • Briefings on HIPAA

    How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...

  • APCs Insider

    This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations...

Most Popular