House of Representatives Finally Agree with Senate “Patch,” and Senate Agrees Conference to Negotiate Longer Term Deal.
On December 17^th, in a rare Saturday session of the Senate, the Senate passed by a vote a 89-10 a two month “patch,” to allow for negotiations to continue in the new year with Congress trying to find the money to pay for a longer time frame of no new cuts, with then none of the cuts going into effect on January 1, including the 27.4 % cut to Medicare physician payment. 

Tuesday, December 20, 2011, the U.S. House of Representatives by a vote of 229 – 193, with seven Republicans crossing over to vote with the Democrats, effectively rejected the bill the Senate-passed on Saturday by voting in favor of a House-Senate conference on the bill.

The House then held a symbolic vote in favor of a long-term extension similar to the version the House passed last week in a largely party-line vote. The House passed bill included a 24 month SGR provision with a 1% update to Medicare physician payments.  Republicans in the House see this 24 month period as part of the transition period that physicians would need to adopt a new physician payment system that would move physicians away from traditional Medicare fee for service. Hearings and potentially committee action and a House vote could happen next year setting in motion such a transition. 

On December 22, 2010 House Republican leaders have agreed to take language from the Senate-passed two-month payroll tax cut extension bill (HR 3630). The House will take up a new bill on the 23^rd that will reflect this agreement and pass it by unanimous consent and the Senate will follow suit.  The Senate agreed to appoint two of its members to continue discussion with House on a longer term bill that would be enacted before February 29, 2012.  

Knowing that physicians are concerned about their ability to maintain access for their patients, the Medicare program issued the following guidance:

“Attention Health Professionals:  Information Regarding the Holding of 2012 Date-of-Service Claims for Services Paid Under the 2012 Medicare Physician Fee Schedule

The negative update under current law for the 2012 Medicare Physician Fee Schedule is scheduled to take effect on January 1, 2012, eight business days from today.  Consequently, as on numerous occasions in the past, the Centers for Medicare & Medicaid Services (CMS) will instruct its Medicare claims administration contractors to hold claims containing 2012 services paid under the Medicare Physician Fee Schedule for the first 10 business days of January (i.e., January 1, 2012, through January 17, 2012).  The hold should have minimal impact on provider cash flow because, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt. 

Medicare Physician Fee Schedule claims for services rendered on or before December 31, 2011, are unaffected by the 2012 claims hold and will be processed and paid under normal procedures and time frames.

The Administration is disappointed that Congress has failed to pass a solution to eliminate the sustainable growth rate (SGR) formula-driven cuts, and has put payments for health care for Medicare beneficiaries at risk.  We continue to urge Congress to take action to ensure these cuts do not take effect.

CMS will notify you on or before January 11, 2012, with more information about the status of Congressional action to avert the negative update and next steps regarding the claims hold.”

And CMS also extended the 2012 Annual Participation Enrollment Period through Tue Feb 14, 2012.  The enrollment period now runs Mon Nov 14, 2011 through Tue Feb 14, 2012. 

The effective date for any participation status change during the extension, however, remains Sun Jan 1, 2012, and will be in force for the entire year. 

To learn more about your enrollment options, visit http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/medicare/medicare-participation-guide.page