Otolaryngology Coding Alert

Plus: Extra pay could be coming your way this summer. 

The Medicare Access and CHIP Reauthorization Act (MACRA) is official and the Act is bringing important changes to every physician practice, thanks to work by the U.S. Congress and President Obama. 

From a reimbursement perspective, MACRA eliminates the SGR formula for Medicare physician payment once and for all. Congress has passed 17 SGR “patches” since 2002, which has made both legislators and physicians wary about simply moving the problem forward yet again.

MACRA now gives 0.5 percent annual boosts to your Medicare pay for almost five years starting in July, after which practitioners will get bonuses based on quality of care rather than the number of procedures performed. As for your current payments, you’ll continue to collect based on the rates that were in effect from Jan. 1 through March 31, giving MACs and practices time to prepare their systems for the new payment formulas that will kick in on July 1.

The cost of the plan would reportedly amount to about $200 billion over the next decade, and some of that cost could be passed on to higher-earning Medicare beneficiaries. 

An amendment to the bill included a proposal that would have ended therapy caps, but that amendment was rejected, meaning that physical, occupational and speech therapists will continue to face reimbursement caps for their services.

Medical associations were very pleased with the outcome, allowing doctors to focus on offering patients care rather than continually worrying about payment patches. “Passage of this historic legislation finally brings an end to an era of uncertainty for Medicare beneficiaries and their physicians—facilitating the implementation of innovative care models that will improve care quality and lower costs,” said the AMA’s Executive Vice President and CEO, James L. Madara, MD, in a statement. “Patients will be able to get the care they need and deserve.”

Be ready: There is no further ICD-10 delay stipulation in the legislation this year, but Rep. Ted Poe (R-TX) introduced a new bill (H.R. 2126) on April 30 that would “prohibit the Secretary of Health and Human Services from replacing ICD-9 with ICD-10 in implementing the HIPAA code set.” The bill was referred to the Committee on Energy and Commerce and the Committee on Ways and Means. 

AHIMA and the Coalition for ICD-10 have called on ICD-10 supporters to continue their advocacy efforts and contact their representatives and senators to prevent any further delay of ICD-10. Your practice still needs to be ready for the Oct. 1, 2015 implementation deadline, in case this newest development doesn’t gain traction. 

Resource: To read the complete text of the bill, visit www.congress.gov/bill/114th-congress/house-bill/2/text. To learn more about Rep. Poe’s bill, see https://www.congress.gov/bill/114th-congress/house-bill/2126/cosponsors.