HAP Radiology Billing and Coding Blog

SGR Delay Averts 2014 Medicare Physician Reimbursement Cut

Posted: By Barbara Conrad on April 04, 2014

SGR Temporary fixOn April 1st, President Obama signed into law the Protecting Access to Medicare Act of 2014 that delays for 12 months a permanent repeal of the SGR and averts a 24% Medicare physician pay cut that was scheduled to begin April 1st. The bill also extends the 0.5% provider update until March 31st, 2015. Somewhat unexpectedly, the bill also delays ICD-10 implementation until at least October 1, 2015.

 

The failure to permanently fix the SGR did not sit well with physicians. The American Medical Association (AMA) expressed disappointment “that the fight for SGR repeal must continue” after Congress “failed to seize a historic opportunity."  While the American Medical Association and other organizations have worked to block ICD-10 for over a decade, others are dismayed by the delay after gearing up for what was to be an immovable deadline this year. Hospitals, physicians and medical coding professionals have invested vast resources in systems and training to accommodate the expanded diagnosis coding system. It is unclear whether or not advance implementation will be allowed for those who are ready by the October 1, 2014.

Included in the bill are specific provisions that will impact radiology reimbursement in the coming years:

  • Beginning in 2017, CMS will only pay for advanced diagnostic imaging services provided in imaging centers or hospital outpatient departments (including emergency departments) that meet appropriateness criteria established by a qualified decision support system. The Secretary of HHS will be required to define these clinical decision support tools.

  • In an effort to improve patient safety, the technical component of imaging services performed on CT scanners that do not demonstrate compliance with radiation dose standards will be reduced by 5% in 2016, and by 15% in 2017 and afterward.

  • The American College of Radiology was instrumental in another provision that forces CMS to produce the evidence to justify the 25% Multiple Procedure Payment Reduction (MPPR) on certain imaging procedures provided to the same patient on the same day in the same session.

The annual review of the Medicare rules will bring changes to the program as usual at the end of the year, but it is highly unlikely that any further action on the SGR formula will take place
during 2014. The matter will await action by the newly reconstituted Congress early in 2015.

Topics: radiology reimbursement, physician reimbursement, medicare reimbursement

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