May 28, 2010

SGR Fix Delayed in "Extenders" Bill

The prospect of a 21 percent cut in Medicare physician reimbursement starting June 1, 2010 continues to loom as Congress has yet to reach a compromised on an "extenders" package to address a number of expiring provisions -- including the Sustainable Growth Rate (SGR) fix.

Last week Congress appeared to heading towards a multi-year temporary fix that would have provided small positive updates from now until 2014. However, in the face of members concern about federal spending, Democratic leaders have significantly scaled back several parts of the extenders bill, and it now only provides the 18-month fix to the SGR formula.

The latest proposal being considered would provide a 2.2 percent increase in Medicare physician payments for the reminder of 2010, and a
1 percent increase in 2011. Medicare payments would revert to the current flawed SGR formula starting in 2012, meaning physicians would once again face reimbursement cuts in the neighborhood of 20 percent.
While the House appears to have reached an agreement to move forward with this proposal, the Senate has announced that it will not consider the legislation before the Memorial Day recess. The means the 21 percent cut will technically take effect June 1, 2010. However, Congress is expected to pass the SGR fix as part of an extenders bill immediately after the Memorial Day recess and make the payments retroactive to June 1, 2010. Medicare carriers have been instructed to hold claims for 10 days and are poised to pay claims at the new rate -- as soon as Congress acts.

The ATS joins the rest of the physician community in growing frustration that Congress continues to duck responsibility for enacting a permanent solution to the SGR problem. The continued reliance on short-term fixes only increases the cost of fixing the problem later on. The ATS calls on Congress to move quickly to enact a permanent fix to the SGR formula.

CLINICAL PRACTICE

5-Year RUC Review Survey

In preparation for the American Medical Association/Specialty Society RVS Update Committee (RUC) Five-Year Review meeting, the American Thoracic Society (ATS), in conjunction with the our sister societies, have agreed to survey the following two codes:

CPT 94660 Continuous positive airway pressure ventilation (CPAP), initiation and management code.

CPT 36600 Arterial puncture, withdrawal of blood for diagnosis.

The survey will collect updated information to quantify the amount of physician time, intensity and medical decision making involved in performing these services.

The ATS invites you to participate in this survey effort. ATS staff is available to answer any questions that you may have regarding the survey process.

If you are interested in completing the surveys, please respond to CodingQuestions@thoracic.org. In your email, please include:
1. Your full name
2. The state where you practice
3. Your telephone number with the area code 4. The e-mail address to which you want the survey link sent 5. An estimate of how many times you have reported 36600 or 94660 in the past 12 months The deadline for responding to this e-mail is June 4, 2010. The survey will be launched in mid June.

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