Fixing the "Doc Fix"


By Sally Eggleston, MBA, RT(T)

Websites and blogs have been exploding the past week with news that Washington lawmakers are considering a bipartisan bill that would repeal Medicare’s Sustainable Growth Rate (SGR). The bill is getting a lot of buzz and, if passed, could affect you and your medical practice.

While not treading on territory that’s completely new, we would see a fundamental change from the volume-based system you’ve grown to love or hate, depending on your perspective. No longer will billing more procedure codes guarantee you more money. And what will we have to keep us in suspense every three, six or 12 months other than SGR repeal?

Called the SGR Repeal and Medicare Provider Payment Modernization Act, changes include:

  • SGR repeal
  • An annual update of 0.5 percent from 2014 through 2018
  • 2018 rates remaining through 2023
  • Incentives available through MIPS

Haven’t heard of MIPS? That’s not surprising. Interestingly enough, MIPS is the acronym for the Medicaid Integrity Program System. The Centers for Medicare & Medicaid Services (CMS) states that “the primary purpose of the system is to collect and maintain information needed to provide a mechanism for CMS' central and regional office to capture, track, manage, report and trend inquiries, complaints and issues related to Fee-for-Service programs.”* The MIPS would consolidate the incentive programs that you should be aware of and are possibly now participating in: PQRS (Physician Quality Reporting System), Value-Based Payment Modifier and Meaningful Use. As you may know—or should know—these incentive programs are not easily attained and the administrative burden is great.

Whether this SGR repeal is an inordinate idea or not, the billion-dollar question remains, “How will this be paid for?” This coupled with the fact that timing is everything and with the debt ceiling looming, the question of timing is even more critical. The April 1, 2014 deadline for the temporary “doc fix” to expire would equate to a roughly 24 percent reduction in the conversion factor, which will affect every physician in the country, regardless of specialty. While the passage of the Medicare Provider Payment Modernization Act would prevent this cut by repealing the SGR, its failure to pass will most likely mean another “doc fix.” We’d hope it would be a nine-month fix, so that physicians and their claims processing entities don’t have to deal with held claims or refiled claims thanks to legislators not passing the bill according to deadline, which has been the case in the past.

Ultimately, something has to be done with the SGR. Whether the end result will satisfy a majority of physicians will remain to be seen. In any case, the administrative burden in reporting incentives will be a permanent part of any medical practice.

What we know for sure is that our healthcare industry is ever-changing, and for your practice to thrive you’ve got to stay updated. RC Billing can help keep you informed, navigate you through change and adapt your operations so you can focus on your patients’ care and maintain a solid bottom line. Find out what we can do for you by calling 512-583-2000.


*http//www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/Privacy/Systems-of-Records-Items/09-70-0599-MIPS.html?DLPage=1&DLSort=0&DLSortDir=descending

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