Health Information Management

Senate passes SGR bill, extends 2-midnight probe and educate audits

HIM-HIPAA Insider, April 20, 2015

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After a two-week hiatus, Congress passed the Medicare and Children's Health Insurance Program (CHIP) Reauthorization Act (MACRA) April 14, ending the 17-year battle over cuts to physician reimbursement associated with the Sustainable Growth Rate (SGR).

The House overwhelmingly passed a bipartisan bill March 26 to permanently fix the SGR, but the bill’s fate remained unclear as it landed with the Senate shortly before its two-week recess. In the interim, a 21% “negative update” in Medicare physician reimbursement became effective April 1. However, CMS instructed providers to hold claims with dates of service on or after April 1 for 10 business days, after which time the Senate voted on and passed the bill.
The bill will increase physician payments by 0.5% annually for the next four years, after which physicians will likely see annual payment increases of 0.25%.
In addition to addressing the SGR, the bill will extend the probe and educate audit period for the 2-midnight rule through September 30. Previously, the 2-midnight rule was limited to pre-payment reviews through March 30, unless auditors found evidence of systematic gaming, fraud, abuse, or delays in the provision of care. The bill implements the September date despite the fact that CMS extended the audits through the end of April while it waited for the Senate vote.
During the 2014 congressional battle over the SGR, a last-minute amendment delayed ICD-10-CM/PCS implementation from its then-current date of October 1, 2014. CMS subsequently moved implementation one year out to its present deadline of October 1, 2015. No delay language was included in this year’s SGR repeal.
Click here to read more on the HCPro website.

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