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SGR Update: CMS Says U.S. Senate Delay Won’t Affect Physician Payments

From the American Academy of Ophthalmology 

Agency Prepared to Handle Short-Term Reimbursement Delay until Congress can Fix Flawed System

The U.S. Senate’s vote on Medicare’s sustainable growth rate formula will not happen until it returns from a two-week recess. As a result, the Centers for Medicare & Medicaid Services is providing payment protections for physicians who would otherwise face a 21 percent cut April 1.

Despite intense pressure from the physician community, the Senate adjourned Friday without passing legislation that would permanently repeal the sustainable growth rate formula. Senate Majority Leader Mitch McConnell, R-Ky., said the Senate would act on the House-passed SGR repeal package "very quickly when we get back" from recess.

Current law allows physicians to receive payment for Medicare claims submitted once the cut takes effect. Thanks to the law, CMS will not pay electronic claims sooner than 14 days after receipt and paper claims sooner than 29 days after receipt, so no payments would be made until April 14.

CMS has indicated that it will notify providers on or before April 11 with more information on the next steps.

Claims for services rendered on or before March 31 will not be affected and will be processed and paid under normal procedures.

The bipartisan bill unanimously passed in the U.S. House Thursday, and President Barack Obama says his pen is ready to sign this “good bipartisan” bill into law. 

Academy members must continue urging Senate passage of the bill that would get rid of the flawed physician funding formula — permanently. Tell your Senators that it is their responsibility to pass Medicare reform and repeal the SGR once and for all.

For addition information or questions contact Chantay P. Moye, the Academy’s advocacy communications manager in the Washington, D.C. office at cmoye@aaodc.org.