Cardiology Coding Alert

Make the most of the extra time before implementation, experts advise.

The Protecting Access to Medicare Act of 2014 has been a hot topic in healthcare lately. Congress introduced the bill to delay the 24 percent pay cut your practice was due to face on April 1. 

The bill also included another change buried in the text that has a major impact on your practice. Take a look at what you need to know to keep your practice up to date. 

Don’t Expect a Permanent SGR Fix This Time

Background: As most practices are aware, the 24 percent pay cut that you were supposed to face on Jan. 1 was prevented, thanks to a Congressional vote earlier this year. However, that delay would have expired on March 31, without another government vote, and your Medicare payments would have faced the same 24 percent cut on April 1.

Good news: On March 27 Congress introduced the Protecting Access to Medicare Act of 2014 (HR 4302), which halts the 24 percent pay cut for the rest of the year. The House of Representatives quickly passed the bill on March 27, and the Senate passed it on March 31. President Obama then signed the bill into law on April 1.

The newly passed law replaces the reimbursement cut with a 0.5 percent payment update through the end of 2014 and a zero percent payment update from January 1, 2015, to March 31, 2015. 

Bad news: This new legislation only provides a temporary solution, not a permanent fix to the Medicare sustainable growth rate (SGR) formula that leads to these looming pay cuts every year. Many industry groups are lamenting the lack of a long-term solution. 

 “The SGR needs to be fixed permanently by Congress,” says Catherine Brink, BS, CMM, CPC, CMSCS, president of Healthcare Resource Management Inc. in Spring Lake, N.J. “The temporary fix at least keeps practices’ Medicare revenue on track for now anyway.”

Check Out the ICD-10 Changes

The bill also includes a short paragraph that states, “The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD-10 code sets as the standard for code sets.” This means that because the bill has been signed into law, ICD-10 will be delayed for at least another year beyond the scheduled Oct. 1, 2014, implementation date. 

While many feel this new law and resulting ICD-10 implementation delay is not good for practices, there may be a small silver lining. “I think it is a bad thing because it affects our momentum to crossing the finish line,” explains Laureen Jandroep, CPC, CPC-I, CMSCS, CHCI, senior instructor at CodingCertification.org in Oceanville, N.J. “However we can use the extra time to prepare even more thoroughly so we can make the best of it. For those that have made the investment getting ready it is frustrating to see their investment lose traction.”

Despite the delay in implementation, experts warn that practices must continue their efforts to prepare for 

ICD-10 use. “Part of the reason we’re in this situation is not enough people have prepared and petitioned for more time,” Jandroep says. “It is not fair to those that did prepare and are ready or were going to be by the Oct. 1, 2014, date. The changes are in the implementation date, not that it is not coming at all, so prepare on!”

“Of note, we should not throw away the chance to improve the physician’s clinical documentation just because the code set implementation has been delayed,” adds Barbara J. Cobuzzi, MBA, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J. “It is always a goal to improve clinical documentation.”

To read the complete text of the Protecting Access to Medicare Act of 2014, visit http://docs.house.gov/billsthisweek/20140324/BILLS-113hrSGR-sus.pdf.