Part B Insider (Multispecialty) Coding Alert

Published on Fri Feb 15, 2013 PDF

Plus: DOJ nails nurse who submits claims even though facility is closed for snow day.

Every year, physicians bite their nails at the end of December, waiting to find out whether Congress will vote to reverse the massive Medicare cuts that are projected annually, thanks to the Sustainable Growth Rate (SGR) formula that the government uses to set payment rates. But could next year be different?

If two legislators are successful, it could be. Representatives Joe Heck, DO (R-NV) and Allyson Schwartz (D-PA) introduced the Medicare Physician Payment Innovation Act on Feb. 6 to offer a new alternative to the SGR formula. The new regulations would offer an annual positive payment update to all physicians for four years, ensure access to preventive care, "aggressively" evaluate new payment and delivery models, offer more than one payment model, and stabilize payments for providers who demonstrate their "commitment to quality and efficiency within a fee-for-service model," Heck notes on his Web site.

The AMA instantly supported the legislation. "Reps Schwartz and Heck clearly understand that this decade-long cycle of scheduled cuts and short-term patches must end so we can protect access to care for Medicare patients, reward quality and reduce costs," AMA President Jeremy Lazarus, MD, said in a Feb. 6 statement.

The AMA also noted that the cost of repealing the SGR would be $138 billion, which is over $100 billion less than the previous projection, "and less than the $146 billion Congress has already spent on short-term patches to the SGR over the past decade," Lazarus added.

Resource: To read a summary of the legislation, visit Rep. Heck’s Web site at http://heck.house.gov/press-release/heck-and-schwartz-introduce-bipartisan-legislation-repeal-sgr-and-reform-medicare.