Consensus on SGR Fix Eludes Congress; CMS to Temporarily Hold Processing Claims
Absent the passage of compromise legislation in both the House and Senate, Medicare physician reimbursement rates for radiologists and all other physicians are scheduled to be reduced by 27.4 percent on January 1, 2012. These draconian cuts are directly attributed to the flawed Sustainable Growth Rate (SGR) formula.
On Tuesday, December 13, the House of Representatives passed H.R. 3630, the Middle Class Tax Relief and Job Creation Act, which, among other things, replaces the scheduled reimbursement cuts with a 1 percent increase in 2012 and 2013. This comprehensive piece of legislation, however, also sought to extend the current payroll tax holiday and unemployment insurance benefits for an additional year, as well as require President Obama to complete an expedited review of the Keystone XL Pipeline. Unfortunately, partisan differences related to the payroll tax holiday, unemployment insurance benefits and Keystone XL pipeline forced the Senate to convene a rare weekend session to amend the House-passed version of H.R. 3630. On Saturday, December 17, the Senate passed a bipartisan compromise which would only cancel the anticipated SGR reductions for two months. Unhappy with the compromise plan, the House of Representatives elected not to bring up the Senate amended version of H.R. 3630 for a vote and, instead, passed a resolution requesting the two chambers meet to iron out the differences in a Congressional conference committee. The Senate has already adjourned for the holiday recess and it is unclear whether the Senate will come back to rectify the differences in H.R. 3630 prior to the State of the Union Address, scheduled for January 24, 2012.
In light of Congress’s inability to reach consensus, the Centers for Medicare and Medicaid Services (CMS) instructed its claims contractors to withhold physician payment claims for the first 10 business days of 2012. CMS states that this decision will have minimal impact on provider cash flow because, under current law, clean electronic claims are not paid sooner than 14 calendars days (29 days for paper claims) after the date of receipt. Medicare Physician Fee Schedule claims for services rendered on or before Saturday, December 31 are unaffected by the 2012 claims hold and will be processed and paid under normal procedures and time frames. CMS is also expected to release additional information on or before Wednesday, January 11, 2012, regarding future plans for withholding payment for physician fee schedule claims. Please continue to monitor the ACR website for additional information.
