Medicare physician pay was cut by approximately 21% effective April 1, due to the expiration of the last temporary fix to the Sustainable Growth Rate formula.
Because legislation to repeal the SGR has passed the House and awaits action in the Senate, the Centers for Medicare & Medicaid Services announced it will hold Medicare payments for 2 weeks, allowing Congress to complete action on the issue.
Without a legislative fix, beginning April 15, “CMS will begin processing claims received on or after April 1 with a 21% reduction in the physician’s rate to limit the impact on Medicare providers and beneficiaries,” the agency said in a statement.
The House on March 26 overwhelming passed H.R.2, the Medicare Access and CHIP Reauthorization Act, which would repeal the SGR, reauthorize the Children’s Health Insurance Program for 2 years, and reform Medicare. The Senate did not address the bill before taking a recess until April 13.
Should SGR repeal legislation pass Congress and be signed by the President – something he has indicated he will do – CMS will reprocess any claims processed at the lower rate.