Physician Practice

SGR update: Medicare processing will forestall cuts

Physician Practice Insider, April 7, 2015

The 21% "negative update" in Medicare reimbursement for physicians mandated by the Sustainable Growth Rate (SGR) funding formula went into effect April 1, but physicians will have some lag time to account for processing before the cuts take place, according to CMS.

"The Administration urges Congress to take action to ensure these cuts do not take effect," CMS said 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."

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. That 14-day window pushes the drop-dead date for the SGR cuts 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.

Click here to read more via HealthLeaders Media.

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