Medicare Reform Signed by the President
On Thursday, President Obama signed the Medicare Access and CHIP Reauthorization Act (MACRA) legislation repealing Medicare’s sustainable growth rate formula, two days after the Senate passed the bipartisan bill.
The bill overhauls a 1997 law designed to slow Medicare's growth by limiting reimbursements to physicians. It eliminates the -21% cut that was to have begun on April 1, 2015. The new legislation means that doctors will no longer have to worry every year about massive cuts from Medicare. It also fixes the SGR "patch" worries that have occurred each year.
The House approved the bill on March 26 and the Senate passed the bill two days ago. President Obama signed the bill yesterday, April 16.
The Medicare Administrative Contractors were instructed to implement the new rates in the legislation; however, the MACS (Palmetto GBA in WV) have stated that a small volume of claims have been processed at the reduced rate based on the negative update amount. Palmetto GBA has announced that the carrier will automatically reprocess claims paid at the reduced rate with the new payment rate. No action is necessary from providers who have already submitted claims for the impacted dates of service.
The WVSMA is striving to keep you updated on the latest developments of this important legislation. Please check our website (www.wvsma.org), Facebook or Twitter for additional information.
Here are some of the highlights of this new legislation:
The SGR formula is repealed immediately.
The 21 percent payment cut scheduled to take place April 15 was halted, and a positive payment update of 0.5 percent will take effect July 1.
The 0.5 percent payment update will be applied through 2019
. Claims that were held for the first half of April will be processed and paid at the rates that were in place before the 21 percent cut was scheduled to take effect.
Medicare's current quality reporting programs will be streamlined and simplified into one merit-based incentive payment system, referred to as "MIPS.
" This consolidation will reduce the aggregate level of financial penalties physicians otherwise could have faced. Protections are included so that medical liability cases cannot use Medicare quality program standards and measures as a standard or duty of care.
Incentive payments will be available for physicians who participate in alternative payment models and meet certain thresholds
Technical support will be provided to help smaller practices participate in alternative payment models or the new fee-for-service incentive program.