Archive | April 2010

President signs H.R. 4851, the Continuing Extension Act of 2010

Last night, the President signed H.R. 4851, the Continuing Extension Act of 2010, into law, reinstating Medicare physician payments to where they were on March 31 and again postponing the 21.3 percent cut that was supposed to take effect in 2010. This most recent extension of 2009 payment rates will continue through the end of May, and will be applied retroactively to all physician services provided to Medicare patients in April.  The legislation passed the Senate at about 5:45 last night by a bipartisan vote of 59-38, and subsequently passed the House shortly after 8:00 pm by a bipartisan vote of 289-112.

Yesterday, the hold on processing April claims that the Centers for Medicare & Medicaid Services (CMS) had placed to avoid implementing the payment cut technically expired.  However, with Congressional action so imminent, we do not believe many claims were actually processed at the lower payment rates.  However, we have been informed by CMS that any claims paid that reflected the 21.3 percent cut will be reprocessed automatically without any action required from physicians.

The AMA is continuing to work closely with House and Senate leadership offices and with White House officials on a long-term solution to the sustainable growth rate formula, and we expect to have more to report on these efforts very soon.

“Stop the Medicare Meltdown” – Sponsored by America’s Medical Societies

Save Medicare Today

Doctors want to take care of Medicare patients. Congress is forcing doctors to limit the number of Medicare patients we see or to quit taking Medicare patients altogether.

When it comes to health care reform, America’s doctors keep telling Congress to “keep what’s good in our health care system and fix only what’s wrong.” Something that is very wrong is the formula Medicare uses to pay physicians. Each year for the past decade, physicians have faced steep payment cuts that make it harder and harder for them to care for their Medicare patients. Congress knows about the problem. They know the faulty formula Medicare uses to pay doctors does not work but they have not fixed the problem. We need your help to convince Congress to fix Medicare now.  Please sign the petition and send it to your friends to sign as well.

Please fix Medicare by developing a rational Medicare physician payment system that automatically keeps up with the cost of running a practice and is backed by a fair, stable funding formula.

Visit and sign the petition today.

Senate Invokes Cloture on Temporary SGR Patch

This afternoon, the Senate invoked cloture on the motion to proceed to H.R. 4851 by a vote of 60-34, which extends a number of expiring programs, including a reprieve from the 21 percent Medicare physician payment cut that was originally scheduled to take effect on January 1.  Other expiring programs addressed by the bill include extended unemployment insurance benefits and COBRA subsidies for the unemployed.  As of press time, no bipartisan deal has been reached to facilitate quick passage of H.R. 4851.  In the absence of such an agreement, under Senate procedure, a vote on final passage of the bill  may not occur until the end of this week.

As you know, the Centers for Medicare and Medicaid Services (CMS) instructed its carriers to refrain from processing any claims for services provided on or after April 1 for 10 working days, to minimize administrative complications and other disruptions that would result from calculating payments that reflect a rate reduction that Congress is expected to overturn.  That 10 day grace period expires on Wednesday, April 14.  If Congress fails to pass H.R. 4851 or similar legislation by close of business on Wednesday, Medicare law will require carriers to begin processing claims for services provided in April with the 21 percent cut.  That said, we still expect Congress to pass legislation that retroactively restores payments to levels in place prior to April 1.




Westing Forrestal Princeton, Princeton, NJ

A “usual, customary, and reasonable (UCR)” fee is the benchmark for out-of-network payment.  But, what is UCR now? In the not so distant past, healthcare insurers would pay billed charges, or a high percentage of the billed charge for out-of-network fees, but that was then.

Attend the Medical Practice Management Section’s Annual Meeting on Friday, May 14, 2010, to learn all about UCR issues and what MSNJ is doing to impact the determination of UCR fees. Pending class-action lawsuits, New York Attorney General Consent Orders, the discredited Ingenix database, the creation of FAIR, new databases, and possible legislation all will have an impact on UCR.

Come hear our panel of experts talk about all of these matters.

Moderator: Larry Downs, MSNJ General Counsel

Edith Kallas, Esq., Member, Whatley Drake & Kallas, National Class-Action Counsel

Mary Jo Malone, Esq., Executive Director, Physician Advocacy Institute (PAI)

Stephen Foreman, PhD, JD, MPA, Associate Vice President, Academic Affairs & Associate Professor, Health Care Administration & Economics, Robert Morris University

Register here for the MSNJ Annual Meeting or check out the Program Agenda

MEDICARE: 21% Pay Cut Effective April 1

The United States Congress has begun its two-week spring recess after failing to avoid a 21% Medicare fee cut or address the flawed sustainable growth rate (SGR) which MSNJ, AMA and all of organized medicine agree must be repealed. The 21% fee cut went into effect on April 1, 2010, but the Centers for Medicare & Medicaid Services (CMS) has instituted a ten-business-day hold on Medicare claims processing, giving Congress a chance to minimize the impact of the SGR triggered cuts on physicians. This cycle of Congressional inaction and CMS claims processing delays has become an all too familiar theme, although the reliance on shorter, one month freezes is a relatively new phenomenon associated with the “doc-fix” debate over the SGR.  MSNJ thanks our congressional delegation for its support of a long term solution and urges their continued advocacy.

We have been advised that the Senate plans to hold a cloture vote after the recess which, if supported by 60 Senators, will allow a vote to occur on the legislation.  That vote could occur as early as April 12, the day that Congress returns from the spring recess.

Congress’ failure to act in a timely and responsible manner is precisely why the Medicare payment formula must be fixed.  MSNJ will continue to work with the AMA and organized medicine for a repeal of the SGR. Our Senators and a majority of our House members already support this effort. We will continue to work with the delegation to ensure their continued commitment to repeal the SGR.

For details on the vote on H.R. 4851, that would have delayed the Medicare payment cut through April 1, and would have extended a number of programs including unemployment benefits and COBRA, visit AMA’s web site.

We will keep members apprised of developments on the legislation and any efforts required to repeal the SGR.