Pathology/Lab Coding Alert

Senate may act after recess.

It happened — April 1 came and went with no final Congressional action to override the 21 percent Medicare pay cut. 

Although the House passed the Medicare and CHIP Reauthorization Act (MACRA), the Senate failed to vote on the bill before departing for a two-week recess on March 27.

“Their failure to act leaves physicians facing a devastating 21 percent cut in Medicare reimbursements when the current Sustainable Growth Rate (SGR) payment patch expires on March 31,” said Robert M. Wah, MD, president of the AMA, in a March 27 statement.

Peek Inside MACRA

If passed after the Senate recess, MACRA would eliminate the SGR formula for Medicare physician payment once and for all. Congress has passed 17 SGR “patches” since 2002, which has made both legislators and physicians wary about simply moving the problem forward yet again.

The bill would give 0.5 percent annual boosts to Medicare pay for five years, after which practitioners would get bonuses based on quality of care rather than the number of procedures they administer. The cost of the plan would reportedly amount to about $200 billion over the next decade, and some of that cost could be passed on to higher-earning Medicare beneficiaries.

Await Claims Action

There’s still hope that your lab won’t take a financial hit from this Senate delay. Because electronic claims take at least 14 days to process, and paper claims take at least 29 days, your payment could be unscathed if the Senate acts quickly after recess.

“We urge the Senate to immediately address this issue upon their return and once-and-for-all lay this destructive issue to rest by building the stable and sustainable Medicare program that our nation’s patients and physicians need and deserve,” Wah said.