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News & Press: Legislative & Policy Updates

SGR Patch has Expired; Bill to Repeal SGR on Hold for U.S. Senate Vote

Thursday, April 9, 2015  
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WMS Medigram, April 2

The U.S. House of Representatives passed H.R. 2: “The Medicare Access and CHIP Reauthorization Act” (MACRA) last week. The bill would repeal the flawed sustainable growth rate (SGR) formula, but no action will be taken by the U.S Senate until it reconvenes April 13. The current SGR patch, however, expired March 31.

In the meantime, the American Medical Association (AMA) is advising practices to continue charging the current rates or to defer submitting claims. Because Medicare is required by law to pay physicians the lesser of the submitted charge or the Medicare approved amount, the AMA is advising physicians to continue to charge the 2015 rates for April dates of service or defer submitting claims until final action on the legislation is taken.

“In the unexpected event that Congress allows the 21 percent cut to take effect, Medicare would pay physicians at the reduced amount no matter what the physician billed and no further action would be necessary. However, non-participating physicians who have collected balance billing amounts for unassigned claims based on the currently allowed amount could be required to make refunds to their patients based on new, lower balance billing limits,” said Terri Marchiori, director of federation relations for the AMA.

Congress has temporarily fixed the flawed SGR formula with 17 patches in the last 11 years. Physicians are urged to contact their senators about repealing the flawed formula once and for all. Click here for the contact information of Wisconsin’s U.S. senators.