Senate Stays Up Late- Passes SGR Fix Bill, ICD-10 Still A Go 


On April 14 , 2015, Congress burned the midnight oil and passed the Medicare Access and CHIP Reauthorization Act of 2015; the President is expected to sign it shortly.  This law eliminates the negative update of 21% scheduled to take effect as of April 1, 2015, for the Medicare Physician Fee Schedule.   In addition, provisions allowing for exceptions to the therapy cap, add-on payments for ambulance services, payments for low volume hospitals, and payments for Medicare dependent hospitals that expired on April 1 have been extended.


The bill passed 92-8 and without reference to an ICD-10 delay, giving further momentum towards the Oct. 1, 2015 implementation deadline and creating increased urgency for those still preparing for the new medical code set, with all major hurdles now cleared.

CMS will immediately begin work to implement these provisions.


Before the bill’s passage,  senators reportedly “were voting on amendments, three from each party, that seemed sure to lose but let lawmakers demonstrate their disapproval of provisions they opposed.” A Democratic proposal to extend CHIP for four years fell short of the 60 votes necessary to prevail, while conservatives tried to force Congress to pay for the entire $214 billion package.


In an effort to minimize financial effects on providers, CMS previously instituted a 10-business day processing hold for all impacted claims with dates of service April 1, 2015, and later.  While the Medicare Administrative Contractors (MACs) have been instructed to implement the rates in the legislation, a small volume of claims will be processed at the reduced rate based on the negative update amount.   The MACs will automatically reprocess claims paid at the reduced rate with the new payment rate.

Article Provided By Zetter Healthcare

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