Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

Bipartisan House Repeals Medicare SGR Before Senate Vote

By Jacqueline DiChiara

- There are possible new improvements to the Medicare Sustainable Growth Rate (SGR) payment system today as the bipartisan House of Representatives overwhelmingly passed the Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2). This legislation repeals the Sustainable Growth Rate to alleviate Medicare doctors’ long term payment struggle and offers an innovative permanent solution to Medicare repayment.

The bipartisan “doc fix” legislation avoids a twenty-one percent cut in Medicare payments and extends the Children’s Health Insurance Program (CHIP) funding for two years. Its objectives include improving physician payments and actively driving them towards value-based care.

Physicians will receive a 0.5% pay increase for each of the next five years in agreement with the transition to value-based reimbursement.

Providers who receive substantial revenue from alternative payment models or patient-centered medical homes will receive a five percent bonus.

Since Medicare’s inception in 1965, the decision of how much to pay physicians has been an ongoing obstacle to overcome as various Medicare funding policies have come and gone. A variety of new statements are being released in praise of the House’s action on SGR.

“The House of Representatives has voted to remove the dark cloud of financial uncertainty over physician group practices,” says Halee Fischer-Wright, MD, MMM, FAAP, MGMA President and Chief Executive Officer. “Medicare innovation has been hampered far too long by the SGR. The Senate is one vote away from returning stability to patients and physicians in Medicare. MGMA urges the Senate to immediately vote to repeal the SGR.”

In another statement responding to the House vote on the SGR, the Coalition for ICD-10 “applauds Congress for permanently addressing the Sustainable Growth Rate, which has been a significant concern for physicians and the entire healthcare industry for many years.”

The Coalition for ICD-10 also expresses appreciation that the bill excludes a delay to ICD-10 adoption, urging any upcoming amendment to delay is omitted from the final package.

According to the Coalition for ICD-10, the revised coding standard “is a long-overdue improvement to the current ICD-9 coding system, and critical to advancing U.S. health care through improved quality measurement, public health surveillance, clinical research, and healthcare payment.”

The adoption of ICD-10 promotes mainstream sharing of crucially necessary data to precisely assess and quantify both quality and value, the Coalition for ICD-10 maintains.

Robert M. Wah, MD, President of the American Medical Association (AMA) also released a statement applauding the House of Representatives and urging the US Senate to proceed quickly with the implementation of further decisions before the current SGR payment patch expires in the end of March.

“The American Medical Association (AMA) applauds the U.S. House of Representatives for overwhelmingly passing a long overdue bill to permanently eliminate the flawed Sustainable Growth Rate (SGR) formula and put in place important Medicare payment and delivery reforms that will improve the health of the nation,” Wah states.

Wah adds the Senate’s passing of this bill will end Congress’ cycle of passing expensive patches to extend a policy that was generally agreed upon as being ineffective and detrimental.

“The new policy supports innovative new delivery and payment models that will help improve care quality, health outcomes and lower costs,” maintains Wah. “It also assures access to care for children, low-income individuals and families by extending funds for the Children’s Health Insurance Program and community health centers.”

Wah says the Senate must vote today to cease an imminent twenty-one percent cut in Medicare reimbursements. This decision will drive decreases in healthcare access for seniors, military personnel and their families, he explains.

“The time is now to finally lay this destructive issue to rest and act immediately to build a stable and sustainable Medicare program that our nation’s patients and physicians need and deserve,” Wah says.



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