One of the orphan pieces of legislating left over from the enactment of the Patient Protection and Affordable Care Act (PPACA), or the so-called “Affordable Care Act” (Public Law 111-148), was a permanent fix to the Medicare physician fee schedule – the sustainable growth rate (SGR) problem. While Congress passed temporary fixes throughout the first five months of 2010, the 21 percent cut was allowed to take effect on June 18, after a Center for Medicare and Medicaid Services (CMS) imposed claims processing suspension was lifted. In the last days of June, Congress passed a six-month, 2.2 percent positive update (June through November) to the physician fee schedule. CMS has notified providers that it expects claims to be processed at the new 2.2 percent updated rate by July 1, 2010. For providers who submitted claims in June under the 21 percent reduced rate, they must contact their local Medicare contractor to request an adjustment. Kicking this can down the road one more time exacerbates the impact of the SGR problem for physicians and assures another contentious debate in Congress this fall.
About the Author
Robert Betz, Ph.D., is president of Robert Betz Associates, Inc. (RBA), a well-established federal health policy consulting firm located in the Washington, D.C. area. Additionally, Dr. Betz is an adjunct professor teaching at The George Washington University where he specializes in political science and health policy. For more information about RBA, visit www.robertbetz.com.