CMS to cut Medicare rates after April 15 if SGR bill not approved

group of doctors at a laptop

Starting April 15, the Centers for Medicare and Medicaid Services said it will begin reducing physician payment for Medicare claims by 21 percent, the rate mandated under the sustainable growth rate, if legislation is not passed.

The reduced payment will be retroactive to claims received on or after April 1, according to the notice.

[Also: House passes SGR bill by huge margin]

CMS issued the notice to healthcare providers after the U.S. Senate adjourned for a two-week break at the end of March without voting on a bill that would end SGR’s cost-cutting mandate for physician payment.

In addition to the rate delay, CMS said it is pushing back enforcement of the “two midnight rule” for 30 days. The rule sets parameters for how long hospital visits can be before becoming inpatient stays. Critics have said the “two midnights” benchmark is too rigid. The SGR bill  would delay the rule for six months

Senate Majority Leader Mitch McConnell, R-KY, promised quick action on the bill when the Senate returned the week of April 13.

[Also: SGR bill delays 'two midnight' rule]

However, the deadline for the last “doc fix” on SGR expired April 1, which meant the 21 percent pay cut to physicians would take effect at that time.

CMS will delay processing claims, but said any delay after April 15 would negatively affect providers’ cash flow.

“Because we have an obligation to make sure that physicians are paid for services furnished, starting on April 15, we will begin to process claims at the 21-percent lower payment rate if the law is not changed,” CMS said in its notice. Should Congress act after April 15, CMS would reprocess those claims paid at the lower payment rate to reflect the new payment rates, it said.

The bill , H.R. 2, repeals the automatic Medicare payment cuts to doctors and was overwhelmingly passed the House on March 28.

Twitter: @SusanMorseHFN