Healthcare Business News

CMS notice spurs AMA to stress doc-pay fix

By Jessica Zigmond
Posted: December 19, 2012 - 5:00 pm ET

The American Medical Association on Wednesday called on Congress (PDF) to act immediately to avert a looming 27% Medicare payment cut to physicians after a notice from the CMS indicated there will be no delay in the processing of claims payments under the Medicare physician fee schedule.

“The threat is real and a cut of 26.5 percent is simply unsustainable,” AMA President Dr. Jeremy Lazarus said in a statement. “The administration has announced it will not delay processing of Medicare claims, so physicians who care for Medicare patients will see an immediate, drastic cut of 26.5 percent on all Medicare payments for services starting January 1. With no sign of action from Congress, physicians must prepare themselves and their patients for an impending Medicare crisis.”

In a notice to providers Wednesday, the CMS indicated that all claims for services on or before Dec. 31 would be unaffected by the payment cut scheduled to kick in on Jan. 1.

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“We continue to urge Congress to take action to ensure these cuts do not take effect,” according to the notice. “Given the current progress with the legislation, CMS must take steps to implement the negative update.” The CMS also noted that it would provide an update to providers on or before Jan. 11.

Earlier this week, the White House presented a deficit-reduction offer that called for a permanent repeal of the sustainable growth-rate formula and about $400 billion in healthcare cuts. In its analysis of the latest GOP plan that House Speaker John Boehner (R-Ohio) announced Tuesday, the Obama administration chided House Republicans for not attempting to fix the SGR and noted that reducing physician payments by $39 million each day the SGR is not addressed would compromise care for about 50 million people with Medicare and destabilize the program.

The House Ways and Means Republican staff shot back at the White House analysis, saying the CMS has delayed processing reimbursements several times in recent years. For instance, the Obama administration took this approach in the summer of 2010.

Meanwhile, committees in both congressional chambers are considering a two-year fix to the SGR during the ongoing fiscal-cliff negotiations, according to a GOP aide familiar with the discussions. Lawmakers have not decided whether that short-term solution would be wrapped up in a deficit-reduction deal or appear in other legislation.

They have also not decided how to pay for the patch, although one possibility is for Congress to use the funds it would collect by requiring the repayment of excess premium assistance subsidies paid to enrollees in the health insurance exchanges. Congress used this funding source more than a year ago when it overturned the Affordable Care Act's Form 1099 reporting requirement.

“It provides certainty for the doctors, and the Democrats have used it in the past, so it is an approach that has some bipartisan roots,” the aide said in an e-mail.

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