CMS begins paying claims at lower SGR rate

By staff writers

June 21, 2010 -- The U.S. Centers for Medicare and Medicaid Services (CMS) on Friday began processing claims for reimbursement under the Medicare Physician Fee Schedule (MPFS) using a 21.2% cut due to the sustainable growth rate (SGR) formula, despite the passage of legislation in the Senate last week that would postpone the cuts.

CMS implemented the lower rates after the most recent SGR delay deadline expired on May 31; CMS had asked its contractors to hold claims until June 14, and the agency then further extended that reprieve until June 17. CMS is paying claims at the lower rate retroactive to June 1.

The Senate on Friday voted to delay cuts to the MPFS mandated by the SGR formula through November 30 of this year with the passage of S 3962. But the fix came too late to impact the decision by CMS.

Senate majority leader Harry Reid (D-NV) and Senate Finance Committee chair Max Baucus (D-MT) cut the SGR patch legislation from another revised version of HR 4213, the American Workers, State, and Business Relief Act of 2010, because of opposition to increased deficit spending that attaching the fix to the bill would cause, according to Congressional Quarterly.

S 3962 will be paid for by a $4.2 billion cut in hospital Medicare reimbursement, an offset gained by changing a Medicare policy called the "72-hour rule." Under the rule, hospitals are prohibited from unbundling payments for therapeutic services unrelated to a hospital admission if they are performed within 72 hours of the admission, according to Senate Finance Committee documents. If passed by the House, it will also increase payments to providers by 2.2%.

On Friday, House Speaker Nancy Pelosi (D-CA) slammed the SGR fix passed by the Senate as "inadequate," according to a Roll Call report. The House may consider the bill this week.

Senate delays Medicare cuts until December, June 18, 2010

Senate committee takes SGR action, June 18, 2010

CMS extends Medicare claim hold, June 14, 2010

Another SGR deadline expected to expire, May 28, 2010

Congress tries again to pass longer-term SGR fix, May 20, 2010

Copyright © 2010


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