At press time, the President still needed to sign the bill in to law.
Although April 1 came and went with no final Congressional action to override the 21 percent Medicare pay cut, things turned a corner by mid-April.
Background: The House passed the Medicare Access and CHIP Reauthorization Act (MACRA), but 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.
Good news: Because electronic claims take at least 14 days to process and paper claims take at least 29 days, the cut would have started affecting your payments on April 15. However, on April 14, just a few hours before the midnight deadline, the Senate voted 92-8 to pass the bill to get rid of the SGR formula. The President is expected to sign the bill into law.
“No more will we be kicking the can down the road with another temporary ‘fix’ to the SGR rate,” said U.S. Senator Ben Cardin (D-Md.), a member of the Senate Finance Subcommittee on Health Care, in a statement.
“Passage of this historic legislation finally brings an end to an era of uncertainty for Medicare beneficiaries and their physicians — facilitating the implementation of innovative care models that will improve care quality and lower costs,” James L. Madara, MD, AMA Executive Vice President and CEO, said in a statement.
Watch For a Boost Next Year
MACRA eliminates 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 gives 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.
“As written, we would see annual physician payment updates of 0.5 percent from 2015 through 2019 and zero percent updates from 2020 through 2015,” explains Michael A Granovsky MD, FACEP, CPC, President of LogixHealth, a national ED coding and billing company. “Starting in 2026, we would see two conversion factors, one that applies to providers that participate in advanced payment models such as an ACO, with a 0.75 percent annual update. A second conversion factor with a 0.25 percent yearly increase would apply to providers who do not participate in advance payment models,” he adds.
Don’t Know the Other MACRA Details
The bill calls for consolidation of three current incentive programs: PQRS, EHR meaningful use, and the value-based modifier program into the new Merit-Based Incentive Payment System (MIPS).
MIPS will assess performance of eligible professionals in four categories (quality, resource use, meaningful use of EHRs and clinical practice) and provide a payment adjustment, which could be positive or negative depending on your composite performance score.
The current penalties in play for meaningful use, PQRS, and value-based modifier would be replaced by MIPS, which rapidly escalates from 4 percent in 2019 to 9 percent in 2022, Granovsky explains.
Additionally: MACRA contains other provisions important to your practice, including:
Know the ICD-10 News, Too
Last year, the House of Representatives included a last-minute addition into the SGR legislation, which delayed the ICD-10 implementation deadline for another 12 months to October 1 of this year. The postponement was the third delay in six years. Industry experts were concerned the same thing would happen again this year.
Be ready: There is no further ICD-10 delay stipulations in the legislation this year, which means your practice needs to be ready for the Oct. 1, 2015 implementation deadline.