No Doc Fix Yet; CMS Processes Claims with 21% Cut

WASHINGTON — Lifting a hold on physician claims that has
been in effect since June 1, CMS sent a listserv last week telling
contractors to begin processing the Medicare docs’ reimbursements
as of June 18 — with a 21.2 percent pay cut.

After several stopgap measures
earlier in the year, in late May, the House approved legislation
(H.R. 4213) that included canceling the cut and giving the docs a
19-month reimbursement increase at a cost of about $23 billion. But
that version of the “doc fix” was not paid for, and the Senate did
not approve the measure. Instead, the Senate passed a $6.4 billion
bill on Friday that staves off the scheduled cuts for only six
months and gives the docs a 2.2 percent increase, so now the House
must take up that measure.

While the pay cut became law June 1, CMS had been holding
affected claims as Congress continued debate. Now, the agency’s
listserv message said, “If Congress changes the negative update
currently in effect, CMS is prepared to act expeditiously to make
the appropriate changes to Medicare claims processing systems.”

Responding to the situation in a statement issued Friday, the
American Medical Association took lawmakers to task for allowing
the drastic cut to take effect.

“Congress is playing Russian roulette with seniors’ health
care,” said AMA President Cecil B. Wilson, MD. “Congress has
finally taken its game of brinkmanship too far, as the steep 21
percent cut is now in effect and physicians will be forced to make
difficult practice changes to keep their practice doors open.

“This is no way to run a major health coverage program,” Wilson
continued. “Already the instability caused by repeated short-term
delays is taking its toll. About one in five physicians say they
have already been forced to limit the number of Medicare patients
in their practice. Nearly one-third of primary care physicians have
already been forced to take that action. The top two reasons
physicians gave for these actions were the ongoing threat of future
cuts and the fact that Medicare payment rates were already too
low.”

The reduced rates will remain in effect unless the House acts on
the Senate proposal. House members will return to work tomorrow
(June 22).