President Obama Signs the Protecting Access to Medicare Act of 2014

On April 1, 2014, President Obama signed into law the Protecting Access to Medicare Act of 2014.  This new law prevents a scheduled payment reduction for physicians and other practitioners who treat Medicare patients from taking effect on April 1, 2014. This new law maintains the 0.5 percent update for such services that applied from January 1, 2014 through March 31, 2014 for the period April 1, 2014 through December 31, 2014.  It also provides a zero percent update to the 2015 Medicare Physician Fee Schedule (MPFS) through March 31, 2015. 

Senate Votes To Delay SGR, ICD-10 For 1 Year

The US Senate has voted for a 1-year “doc fix” preventing a 24% pay cut for physicians who treat Medicare patients, while also delaying by 1 year the implementation of the nationwide conversion to the International Classification of Diseases, 10th Revision (ICD-10), set of diagnostic and procedural codes that was scheduled to occur on October 1.

The bill now awaits President Obama’s signature.

April Update of 2014 Medicare Physician Fee Schedule Database

The April update amends the payment files to the 2014 Medicare physician fee schedule scheduled for implementation April 7, 2014.

In accordance with the Medicare Claims Processing Manual (Publication 100-04), Chapter 23, Section 30.1, this should be considered the prior notice of a change to the 2014 Medicare physician fee schedule.

OIG Work Plan for Fiscal Year 2014

The HHS Office of Inspector General (OIG) Work Plan for Fiscal Year 2014 provides brief descriptions of activities that OIG plans to initiate or continue with respect to HHS programs and operations in fiscal year 2014.

Click here to view this plan.

CMS finalizes physician payment rates for 2014

In a rule issued on November 27, 2013  the Centers for Medicare & Medicaid Services (CMS) finalized payment rates and policies for 2014, including a major proposal to support care management outside the routine office interaction as well as other policies to promote high quality care and efficiency in Medicare. CMS’ care coordination policy is a milestone, and demonstrates Medicare’s recognition of the importance of care that occurs outside of a face-to-face visit for a wide range of beneficiaries beginning in 2015. The final rule sets payment rates for physicians and non-physician practitioners paid under the Medicare Physician Fee Schedule for 2014 and addresses the policies included in the proposed rule issued in July. CMS projects that total payments under the fee schedule in 2014 will be approximately $87 billion.

Read more by clicking here.

CMS Releases Updated PQRS Resources

The Centers for Medicare & Medicaid Services (CMS) has released updated PQRS resources summarizing 2014 reporting requirements for the program. The PQRS program will apply a -2% penalty in 2016 to providers who do not meet reporting criteria in the 2014 performance year. In most cases, providers must report on at least three PQRS measures in 2014 to avoid the 2016 payment adjustment.

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.