No Fix for SGR Problem... Yet!
Possible Cash Flow Problems for Providers
As many of you already know, no action has been taken on enacting a fix to the SGR (Sustainable Growth Rate) problem prior to June 14th. Beginning on June 14th, medical providers should expect that the claims which have been held since June 1st, will begin to be processed and payments for those Part B claims will be at the 21.3% reduced payment level.
Both the House and Senate are working on legislation which will fix the SGR problem but it will be impossible for them to complete any action on the specific legislation and get a bill to the President to sign prior to Monday, June 14th.
It still is anticipated that Congress will eventually pass legislation to restore the full payments for all claims from June 1st, it is not clear when or even how much the payments will be. Congress is focusing their efforts on enacting an SGR fix for a longer period of time, 18 months out, instead of the 1 or 2 month fix that currently has been happening.
When this "fix" does occur, it is still unclear how the claims will be reprocessed by CMS. CMS has not given any indication as to whether the claims will be automatically reprocessed and the additional payment will be received without any further action or if claims will have to be resubmitted to obtain the full payment due.
In addition, this also complicates the task of collecting copays from Medicare patients as well. The copay is 20% of the allowable Medicare fee schedule, so because the fee is decreasing, the copay will decrease as well. If the fix does not happen soon, providers are going to have to collect reduced copay as well for the services rendered. If the reduction is fixed, then patients (or even their secondary insurances) will have to be re-billed at the new rate.
Essential Healthcare Solutions will continue to submit claims as they have been doing and will follow the rules CMS puts forward regarding this issue. When payment is released, EHS reminds you that it will be at the reduced rate. If you have any questions, please give us a call at (801) 593-9223