Late in 2013, President Obama signed into law The Pathway for SGR Reform Act of 2013, which postponed Sustainable Growth Rate (SGR) related cuts to the CMS Professional Fee Schedule (PFS). The SGR cut was forecasted to reduce the Conversion Factor (CF) by over 20%, in turn reducing reimbursements across all specialties. Instead, this legislation delayed those cuts for 3 months and increased the CF by 0.5%, which bumped the 2014 CF to $35.8228. This time was dedicated to allow Congress additional time to consider permanent repeal of the SGR formula.
Legislation allowing for permanent repeal and replacement of the SGR formula has been approved by the Senate Finance Committee and the House Ways and Means Committee. When added to bipartisan legislation adapted earlier in 2013 by the House Energy and Commerce Committee, this totals 3 pieces of legislation that have preliminary support to repeal and replace the SGR. Unfortunately, none of these Committees have announced how they intend to pay for this repeal that is to cost an estimated $116 Billion. Under Congressional rules, the House and Senate cannot consider the SGR legislation unless it is fully funded.
Delaying the cuts to the PFS due to adjustments from the SGR is great news for all physicians in the short term. Unfortunately, delays have been placed in the past, with no permanent fix to the SGR coming to fruition. Funding must be determined and ultimately will have to be adopted through cuts in other areas of the Medicare program. APS will continue to monitor this fluid situation over the next few months and let you know as soon as we have any new information. If you have additional questions in the meantime, please contact your Practice Manager.
In working through the wide variety of billing arrangements, APS found payments that we had been missing.