Since the Senate approved the H.R. 2 Medicare Access and CHIP Reauthorization Act of 2015 and
averted a 21% pay cut, CMS announced an effort to minimize financial effects on providers: They would
institute a 10-business day processing hold for all impacted claims with dates of service April 1, 2015,
On April 15, 2015, CMS announced that these held claims would begin processing with the negative rate
update on a first-in, first-out basis as of April 15. Meanwhile, they will continue to hold new claims as
they are received.
The H.R. 2 Medicare Access and CHIP Reauthorization Act of 2015 eliminates the 21% pay cut for
providers and permanently repeals the SGR formula, replacing it with a formula that will give half of one
percent increases for the next five years, then move all physicians into the value-based payment
In addition, provisions that expired on April 1 allowing for exceptions to the therapy cap, add-on
payments for ambulance services, payments for low-volume hospitals, and payments for Medicare-
dependent hospitals have been extended. CMS is working to implement these provisions.
CMS also announced that while the Medicare Administrative Contractors (MACs) have been instructed
to implement the new rates specified in the legislation, a small volume of claims will be processed at the
21% reduced rate. The MACs will automatically reprocess claims paid at the reduced rate with the new
payment rate. They have advised that no action is necessary from providers who have already submitted
claims for the impacted dates of service.
What does this mean to you short term?
What do you need to do?
- There will be some chaos for Medicare payments until all updates have been loaded and
implemented. Expect to see delays in payments and lower payments until the chaos has
- You and your billing company need to be diligent - monitor the payments from Medicare and
make sure they process correctly.
What does this mean to you long term?
- If they don't process correctly, and are not reprocessed as promised, then follow-up with
Medicare will be needed to make sure you are not leaving money on the table.
- Effectively this means physicians' payments are moving away from fee-for-service towards a
valued-based bundled payment. This is a really big change; it means being great at PQRS and
being great at creating a margin per procedure.
Mick Raich owns Vachette Pathology and works with pathologists, laboratories and hospitals nationwide in the area of strategic management and revenue cycle management. Mick can be reached at 866-407-0763 or 517-403-0763 or via e-mail at [email protected] or visit www.vachettepathology.com.
End of Management of Pathology Practices > The Impact of H.R. 2 on Your Practice & What You Need to Do