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Written by: Darlene D'Altorio-Jones (1959-2015) on Thursday, December 20, 2012 Posted in: Outpatient Rehab

Just in from CMS today (December 19)… asking all professionals to share this news and take action:

“Attention Health Professionals:  Information Regarding the 2013 Medicare Physician Fee Schedule”

The negative update of 27 % under current law for the 2013 Medicare Physician Fee Schedule is scheduled to take effect on January 1, 2013.

Medicare Physician Fee Schedule claims for services rendered on or before December 31, 2012, are unaffected by the 2013 payment cut and will be processed and paid under normal procedures and time frames.

The Administration is disappointed that Congress has failed to pass a solution to eliminate the sustainable growth rate (SGR) formula-driven cuts, and has put payments for health care for Medicare beneficiaries at risk. We continue to urge Congress to take action to ensure these cuts do not take effect. Given the current progress with the legislation, CMS must take steps to implement the negative update.

Under current law, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt. CMS will notify you on or before January 11, 2013, with more information about the status of Congressional action to avert the negative update and next steps.”

They encourage all health professionals to share the news and to take action to avert these next steps!

I provide the following links and information to help you voice your opinion on this dilemma.
The coordination of payment to hundreds of thousands of providers is no easy task and apparently neither are the calculations required to discuss and or update payments toward the sustainable growth rate in the fee for service Physician Fee Schedule.  To be certain, a 27 percent cut in payment for any service seems unconscionable, but here we are faced with this very fact if Congress continues to fail us in providing a solution.  What have you done personally to impress upon your representatives that time is running out? Elections are over and it’s no time to continue posturing; access to care is at stake and healthcare professionals provide that access.  Can you continue to provide your present level of services if a portion of your business suffers cuts of up to 27 percent?  Make a call to the Capital switchboard at 202-224-3121 and ask to speak to your member of Congress.

MedPAC (The Medicare Payment Advisory Commission) sums up the problems as an SRG formula issue stating that the SGR “does not provide incentives for individual physicians to control volume growth, and is inequitable to those physicians who do not increase volume unnecessarily.”  The SRG, “continues to call for substantial negative updates through at least 2016. Such reductions in physician payment rates, if they take place, would threaten beneficiaries’ access to physician services.”

If CMS is to stay on track to make any timely payments at all in 2013 they need to get the ball rolling NOW to set up the infrastructure that enables clean claim payments to be paid after 14 days of the receipt of claims. As you can see there really is no time to waste.