Urology Coding Alert

Decision also means ICD-10 will move forward this year.

Unfortunately, it was no April Fool’s joke that April 1 came and went with no final Congressional action to override the 21 percent Medicare pay cut. 

Although the House passed the Medicare Access 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.

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. President Obama signed the bill into law on April 16. 

“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.

Peek Inside MACRA

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.

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 urology practice needs to be ready for the Oct. 1, 2015 implementation deadline.