The House and Senate have passed a new payroll tax cut bill that also stopped the Medicare payment cut to physicians, and it will now head to President Barack Obama's desk, where it is expected to be signed, according to a Politico report. But what does the bill mean for physicians, surgery centers and the healthcare industry as a whole?
The Middle Class Tax Relief and Job Creation Act of 2012 (pdf) will extend several provisions to Medicare policies:
• Sustainable growth rate: Physicians will not incur Medicare payment cuts of 27.4 percent, and their current Medicare rates will be frozen until Dec. 31, 2012, when the SGR will enact even higher cuts to physician payments to adjust for the economy. The SGR patch is the most expensive fix, as it will cost roughly $18 billion over 10 years. The Department of Health and Human Services and the Government Accountability Office must also issue reports to Congress this year to find a long-term solution to the SGR, according to the bill.
• Physician work geographic adjustment: Payments to physicians who work in a Medicare geographic with a work value below the baseline will be extended. This will cost roughly $400 million over 10 years.
• Outpatient therapy caps: Therapy caps exceptions will be extended through December 31, 2012, with modifications that will require the physician reviewing the therapy plan of care to be detailed on the claim, reject all claims above the spending cap that do not include the proper billing modifier and provide for a manual review of all claims for high-cost beneficiaries to ensure that only medically necessary services are provided. Spending caps, in effect since 2006, will also be extended to hospital outpatient departments.
• Medicaid funding for Louisiana disaster fund: Starting in FY 2014, Louisiana will no longer receive the Medicaid federal disaster matching rate that was provided in the wake of Hurricane Katrina, cutting a total of $2.5 billion.
• Clinical lab payment rates: Payment rates for clinical lab services will be reduced by 2 percent starting in 2013, which will reduce spending by $2.7 billion.
• Prevention and Public Health Fund: The Prevention and Public Health Fund, part of the Patient Protection and Affordable Care Act, will be cut by $5 billion.
The Middle Class Tax Relief and Job Creation Act of 2012 can be viewed in its entirety here (pdf).
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The Middle Class Tax Relief and Job Creation Act of 2012 (pdf) will extend several provisions to Medicare policies:
• Sustainable growth rate: Physicians will not incur Medicare payment cuts of 27.4 percent, and their current Medicare rates will be frozen until Dec. 31, 2012, when the SGR will enact even higher cuts to physician payments to adjust for the economy. The SGR patch is the most expensive fix, as it will cost roughly $18 billion over 10 years. The Department of Health and Human Services and the Government Accountability Office must also issue reports to Congress this year to find a long-term solution to the SGR, according to the bill.
• Physician work geographic adjustment: Payments to physicians who work in a Medicare geographic with a work value below the baseline will be extended. This will cost roughly $400 million over 10 years.
• Outpatient therapy caps: Therapy caps exceptions will be extended through December 31, 2012, with modifications that will require the physician reviewing the therapy plan of care to be detailed on the claim, reject all claims above the spending cap that do not include the proper billing modifier and provide for a manual review of all claims for high-cost beneficiaries to ensure that only medically necessary services are provided. Spending caps, in effect since 2006, will also be extended to hospital outpatient departments.
• Medicaid funding for Louisiana disaster fund: Starting in FY 2014, Louisiana will no longer receive the Medicaid federal disaster matching rate that was provided in the wake of Hurricane Katrina, cutting a total of $2.5 billion.
• Clinical lab payment rates: Payment rates for clinical lab services will be reduced by 2 percent starting in 2013, which will reduce spending by $2.7 billion.
• Prevention and Public Health Fund: The Prevention and Public Health Fund, part of the Patient Protection and Affordable Care Act, will be cut by $5 billion.
The Middle Class Tax Relief and Job Creation Act of 2012 can be viewed in its entirety here (pdf).
Related Articles on Coding, Billing & Collections:
Electronic Funds Transfers to Switch to One Recipient Per Claim
States Hesitate on Health Insurance Exchanges While Future of Reform Law Remains Uncertain
High-Risk Medical Plan Patients to Rack Up Higher Medical Costs Than Expected