April 03, 2014
SGR Patch Legislation Signed into Law, Includes ICD-10 Delay
On April 1, 2014, President Barack Obama signed into law the Protecting Access to Medicare Act of 2014, a 12-month patch to avert a 24.1 percent cut to Medicare physician payment per the Sustainable Growth Rate (SGR) formula.
The law extends the previous 0.5 percent update until December 31, 2014, and includes a 0 percent update from January 1, 2015 to April 1, 2015. With passage of this law, the Medicare anesthesia conversion factor will remain $22.6765 in 2014.
The legislation also includes other provisions that typically have been included with previous SGR patch legislation, such as an extension of the geographic practice cost index (GPCI) floor. Additionally, as an inducement for physician organizations to support the proposal, the patch legislation would delay the transition to codes known as the International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10-CM/PCS) until October 1, 2015. The language of the bill states that, “The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD-10 code sets as the standard for codes sets under section 1173(c) of the Social Security Act (42 U.S.C. 1320d-2(c)) and section 162.1002 of title 45, Code of Federal Regulations." Click here to learn more about the ICD-10-CM/PCS transition.
The American Society of Anesthesiologists (ASA) is concerned about offset or “pay for” provisions related to so-called “misvalued” services. The provision directs the Centers for Medicare & Medicaid Services (CMS) to identify potentially “misvalued” procedures for changes that would result in payment reductions. ASA opposed the inclusion of this provision in the SGR Repeal legislation. Additionally, the patch legislation includes a provision that modifies the current budget sequester in 2024 to provide for a 4 percent across the board cut for all of Medicare for the first six months of that year.
On Sunday, March 2, the ASA Board of Directors voted to take “no position at this time” on H.R. 4015/S.2000, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014.
Recently, CMS announced that they would hold Medicare claims for 10 business days (from April 1 to April 14, 2014). CMS will often hold claims when there is uncertainty over Congressional action on the Sustainable Growth Rate. Click here to view ASA's posting on the CMS announcement about holding claims.
Click here to read a summary of the legislation that was signed into law.