Medicare Compliance & Reimbursement

Implementation questions remain unanswered.

The Protecting Access to Medicare Act of 2014 is making waves throughout the healthcare industry. In a move designed to avert the 24 percent physician pay cut due to begin on April 1, Congress introduced this bill. But this temporary fix includes another change buried in the text that has a major impact on all healthcare providers.

Don’t Expect a Permanent SGR Fix This Time

Background: The 24 percent pay cut that physicians were supposed to face on Jan. 1 was prevented, thanks to a Congressional vote earlier this year. However, that delay would have expired on March 31, without another government vote, and Medicare payments for physicians would face the same 24 percent cut on April 1.

Good news: On March 27 Congress introduced the Protecting Access to Medicare Act of 2014 (HR 4302), which halts the 24 percent pay cut for the rest of the year. The House of Representatives quickly passed the bill on March 27, and the Senate passed it on March 31. President Obama then signed the bill into law on April 1.

The newly passed law replaces the reimbursement cut with a 0.5 percent payment update through the end of 2014 and a zero percent payment update from January 1, 2015 to March 31, 2015. 

ICD-10 Delay Buried in Text

Mentioned about one-third of the way into the 121-page bill is a short paragraph that states, “The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD-10 code sets as the standard for code sets.” This means that, ICD-10 will be delayed for at least another year beyond the scheduled Oct. 1, 2014 implementation date.

Needless to say, professional organizations disagreed strongly with the bill. “AHIMA officials have said that another delay in ICD-10 will cost the industry money and wasted time implementing the new code set,” the American Health Information Management Association said in a March 27 statement.

Even the American Medical Association — which has long advocated for an ICD-10 delay — urged Congress to vote “no” on the bill, although the AMA’s opposition was more focused on the financial provisions. “Full repeal of the sustainable growth rate formula is the answer to strengthening the Medicare program, not another patch,” AMA president Ardis Dee Hoven said in a March 26 statement.

Despite this vocal opposition, the bill was signed into law. But many questions remain about its impact. “AHIMA will seek immediate clarification on a number of technical issues such as the exact length of the delay,” said AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, CAE, FACHE, FAHIMA, in a statement issued immediately after the Senate passed the bill. 

The transition to ICD-10 “remains inevitable and time-sensitive because of the potential risk to public health and the need to track, identify, and analyze new clinical services and treatments available for patients,” the statement added.

For the AHIMA statement please see: journal.ahima.org/2014/04/01/president-signs-sgr-patch-bill-icd-10-officially-delayed/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed:+${JournalOfAhima}+(${Journal})

To read the complete text of the Protecting Access to Medicare Act of 2014, visit http://docs.house.gov/billsthisweek/20140324/BILLS-113hrSGR-sus.pdf.