Physicians Avert Scheduled SGR Pay Cut
President Obama signed into law on Dec. 26, 2013 the Pathway for SGR [Sustainable Growth Rate] Reform Act of 2013 (H.J. Res. 59), narrowly preventing a scheduled Medicare payment reduction for physicians and other practitioners from taking effect on Jan. 1, 2014. The new law extends several provisions of the Middle Class Tax Relief and Job Creation Act of 2012, as well as certain provisions of the Affordable Care Act. Specifically, the following Medicare fee-for-service policies have been extended.
Medicare Physician Payment Update
The new law provides for a 0.5 percent update for Medicare claims with dates of service on or after Jan. 1, 2014 through March 31, 2014. The 2014 conversion factor is $35.8228.
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.
Medicare Outpatient Therapy Services
The exceptions process for outpatient therapy caps is extended through March 31, 2014. In addition, the new law extends the application of the cap and threshold to therapy services furnished in a hospital outpatient department.
Therapy caps are determined for beneficiaries on a calendar year basis, so all beneficiaries began a new cap for outpatient therapy services received on Jan. 1, 2014. For physical therapy and speech language pathology services combined, the 2014 limit for a beneficiary on incurred expenses is $1,920. There is a separate cap for occupational therapy services, which is $1,920 for 2014.
There are two separate $3,700 aggregate annual thresholds: (1) physical therapy and speech-language pathology services, and (2) occupational therapy services.
Ambulance Add-on Payments
The law also extended through March 31, 2014 the 3 percent increase in the ambulance fee schedule amounts for covered ground ambulance transports that originate in rural areas and the 2 percent increase for covered ground ambulance transports that originate in urban areas is extended; and also the provision relating to payment for ground ambulance services that increases the base rate for transports originating in an area that is within the lowest 25th percentile of all rural areas arrayed by population density (known as the “super rural” bonus).