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On February 1, the U.S. House of Representatives gave final approval to the Conference Report for S. 1932, the Deficit Reduction Act of 2005, clearing the way for reversal of the 4.4% cut in Medicare payments to physicians that took effect on January 1. President Bush signed the measure into law on February 8. The Deficit Reduction Act extends 2005 Medicare payment rates through 2006. It does not make any changes to the sustainable growth rate formula, which determines the annual update.
With enactment of the Deficit Reduction Act, Medicare is now paying all 2006 claims at the new, higher rates. If you submitted claims in January that have already been paid, Medicare will reprocess these claims automatically and repay you for the difference. CMS expects that all claims will be reprocessed by July 1, 2006, and has said that physicians and other practitioners paid under Medicare's physician fee schedule can expect to receive several aggregated (versus claim-by-claim) payments.
CMS also plans to offer an additional enrollment period for doctors to reconsider their Medicare participation decision in light of the improved payment situation. The original enrollment period ran from Nov. 15 to Dec. 31, 2005. The extended enrollment period will run an additional 45 days, to begin soon after the enactment of the legislation. The exact starting date of this extended enrollment period has not yet been announced.
CMS has published a fact sheet on the physician update and other payment provisions contained in the DRA. To view the fact sheet, visit http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1779. The ACP has published a Q-and-A sheet that addresses questions physicians may have about billing Medicare. It is available at http://www.acponline.org/college/misc/06med_pay.htm?hp.
Because Congress did not take action to fundamentally reform the SGR, as called for by the AGS, the AMA, and others, physicians face another cut of 4-5% on January 1, 2007, unless lawmakers act this year. The physician community, including AGS, has already begun an advocacy effort to persuade the Congress to address the Medicare physician payment problem.
Your grassroots contacts will be needed to stop further cuts and help AGS make the case for fundamental reforms in the health care system. AGS will keep you posted on further developments related to the 2007 Medicare Physician Fee Update.
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