Archive for December, 2013

President Obama Signs the Pathway for SGR Reform Act of 2013

On December 26, 2013, President Obama signed into law the Pathway for SGR Reform Act of 2013. This new law prevents a scheduled payment reduction for physicians and other practitioners who treat Medicare patients from taking effect on January 1, 2014. The new law provides for a 0.5% update for such services through March 31, 2014. President Obama remains committed to a permanent solution to eliminating the Sustainable Growth Rate (SGR) reductions that result from the existing statutory methodology. The Administration will continue to work with Congress to achieve this goal.

 Section 1101 – Medicare Physician Payment Update – As indicated above, the new law provides for a 0.5% update for claims with dates of service on or after January 1, 2014, through March 31, 2014. CMS is currently revising the 2014 Medicare Physician Fee Schedule (MPFS) to reflect the new law’s requirements as well as technical corrections identified since publication of the final rule in November. For your information, the 2014 conversion factor is $35.8228.

 Section 1102 – Extension of Medicare Physician Work Geographic Adjustment Floor – The existing 1.0 floor on the physician work geographic practice cost index is extended through March 31, 2014. As with the physician payment update, this extension will be reflected in the revised 2014 MPFS.

OIG Amends Safe Harbor Regulations

Final Rule: Medicare and State Health Care Programs: Fraud and Abuse; Electronic Health Records Safe Harbor under the Anti-Kickback Statute

In this final rule, the Office of Inspector General (OIG) amends the safe harbor regulation concerning electronic health records items and services, which defines certain conduct that is protected from liability under the Federal anti-kickback statute, section 1128B(b) of the Social Security Act.  Amendments include:

  • Updating the provision under which electronic health records software is deemed interoperable
  • Removing the electronic prescribing capability requirement
  • Extending the sunset provision until December 31, 2021;

Congress Passes Budget Deal Including 3 Month SGR Patch

On December 18, Congress passed a budget deal which includes a three month reprieve from the 20%+ cuts scheduled to take effect on January 1 due to the Sustainable Growth Rate (SGR) formula. The President is expected to sign the resolution, which provides for 0.5% update to Medicare providers January 1 through March 31, 2014 while also extending the 1.0 work GPCI floor and the therapy caps exceptions process during this time. Lastly, this agreement maintains sequestration reductions for mandatory spending, including 2% sequestration cuts to all Medicare providers through 2023.

CMS Releases Physician Fee Schedules and PRQS Changes for 2014

On November 27, 2013, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2014. The rule also finalizes changes to several of the quality reporting initiatives that are associated with PFS payments, including the Physician Quality Reporting System (PQRS), as well as changes to the Physician Compare tool on the website. Finally, the final rule includes provisions for implementing the value-based payment modifier (Value Modifier) required by the Affordable Care Act that will affect payments to certain groups of physicians based on the quality and cost of care they furnish to beneficiaries enrolled in the traditional Medicare Fee-for-Service program.

The full news release is found here.