CMS Announces Medicare Cuts in Effect Until Such Time as Congress Acts

As a result of Congress’ failure to act on pending Medicare payment legislation, CMS has announced that its contractors have begun to process Medicare claims at the reduced conversion factor rate pursuant to the implementation of the 21% Sustainable Growth Rate (SGR) physician payment cut.

The U.S. Senate continues to debate legislation that includes provisions that would prevent the full implementation of the cut. The current vehicle for addressing the cut is H.R. 4851, the Continuing Extension Act of 2010 as amended. The legislation would vitiate the 21% payment cut and freeze Medicare payment rates at 2009 levels through May 31, 2010. Should the Senate complete action on the bill, House consideration would also be necessary. It is believed that both Houses will act on the legislation by the end of this week and that the President will immediately sign the legislation into law. In the interim, CMS contractors will continue to process claims at the reduced payment level.

The unadjusted anesthesia conversion factor falls to $16.61 per unit and the conversion factor for services paid under the Resource Based Relative Value Scale (RBRVS) will be $28.39 per relative value unit.

ASA continues to closely monitor the situation and will alert members when new information – including any potential retroactive reprocessing of claims as a result of Congressional action - is available. The Society supports permanent repeal and replacement of the SGR methodology as a means to ensure that physicians receive fair and reasonable payment for the care they provide to Medicare beneficiaries and all patients.