As we informed AAN members last week, the US Senate recently put off voting on eliminating Medicare’s flawed sustainable growth rate (SGR) formula until after it returns from recess in mid-April. This means the 21-percent SGR cut will go into effect on April 1.
However, the Centers for Medicare & Medicaid Services (CMS) is telling its carriers to place on hold for 10 business days any claims for services provided on or after April 1. By law, no claims can be paid sooner than 14 calendar days from their receipt. It is anticipated that the Senate will return from recess and vote within this time frame in favor of eliminating the SGR and President Obama will sign the bill.
The American Medical Association is advising physicians to continue to bill claims at the current rates or defer claims until after the legislation passes. In the unlikely event the Senate fails to pass the bill, CMS automatically will reduce rates for the submitted claims, while physicians who are not participating would need to refund their patients the difference between the pre-April 1 rate and the newly reduced rate.