Sustainable Growth Rate Quick Update:
A patch work of temporary relief through 1st quarter 2014. On Dec. 18, Congress passed a limited budget deal which includes a three month temporary reprieve from the 20 percent plus physician payment cuts scheduled to take effect Jan. 1, 2014 due to the Sustainable Growth Rate (SGR) formula.
The budget deal also provides:
0.5 percent update to Medicare providers Jan. 1 through March 31, 2014.
Extend the 1.0 work GPCI floor and the therapy caps exceptions process during this time.
Maintains sequestration reductions for mandatory spending, including two percent sequestration cuts to all Medicare providers through 2023.
This action, while a step forward, is not a repeal of the ongoing flawed SGR formula. The congress still needs to be pushed to finalize a true SGR fix. The discussion of a long term fix for the SGR are approached differently by the house and Senate and remain far from a direct reimbursement solution. Also, it contains a host of issues including a 10 year freeze on payments and introduces alternative payment models. The AUA and other groups are lobbying to pressure for reconciliation that will provide more aspects from the house version, as this version contains more emphasis on Alternative Payment Methods and a chance for improved reimbursement.
The final rule has numerous changes that will affect reimbursement across the board even with a freeze in the conversion factor. AUAcodingtoday.com will include the updates by January 1, 2014. A word of caution: due to the late nature of the balance budget patch, many Medicare carriers will not the updated fee schedule loaded into their systems or posted on their website until mid-2014 take care in calculating amounts billed to patients. As always situational awareness is critical and more so now.
