The Centers for Medicare & Medicaid Services (CMS) has been left with no choice but to begin processing claims, including the 21 percent cut, today, June 18.

Your SCMA is working hard to find both a short and long-term solution to this looming crisis in our country, and has held conference calls with both Senator DeMint and Senator Graham, who are both committed to finding short and long-term fix for the SGR formula.

In a special eVoice Alert yesterday, the AMA stated the following:

As the clock continues to tick toward the June 18 final deadline for implementation of the 21.3 percent cut in Medicare physician payments produced by the sustainable growth rate (SGR) formula, U.S. Senate debate continued June 17 over H.R. 4213, the American Jobs and Closing Tax Loopholes Act. In addition to providing another short-term reprieve from the impending Medicare cut, the legislation would increase federal Medicaid funding and extend various expiring programs, such as disaster relief and long-term unemployment insurance benefits.

If the House and Senate act to avert the cut, claims will be processed as follows:
• If the submitted charge is higher than the new rate, the contractor will automatically reprocess the claim.
• If the submitted charge is lower than the new rate, the physician should call the contractor.
CMS says almost all physicians submit claims for more than the Medicare rates. No one is going to be reviewing the limiting charge for the period that the cut was in place because CMS assumes Congress will ultimately make the fix retroactive.

The Office of Inspector General and CMS are close to releasing a document to waive patient co-pay requirements for situations such as the retroactive increases that were made to the geographic practice cost index increases. CMS will share that document once it is available.

Your SCMA urges you to continue contacting your representatives and senators and let them know that both a temporary and permanent fix is needed in order to protect the patients and physicians in this country.

The SCMA will continue to keep you updated on this matter.