Experience. Integrity. Advocacy.
Experience. Integrity. Advocacy.

Waiting for SGR Reform: What You Need to Know


While Congress is in recess, the Protecting Access to Medicare Act of 2014 expired, theoretically rendering a 21 percent pay cut under the flawed Sustainable Growth Rate (SGR) methodology for physicians who treat Medicare patients. A new bill permanently fixing the SGR, the “Medicare and CHIP Reauthorization Act” (MACRA), passed through the House of Representatives with a wide margin last Tuesday, and the Senate was expected to take up the measure on Thursday, their last day in session before a break for Easter and Passover. Instead, they delayed a vote until their return on April 13.

Meanwhile, the Centers for Medicare and Medicaid Services (CMS) has begun taking measures to enact the new fee schedule, though it’s trying to hold off as long as possible.

“Holding claims for a short period of time allows CMS to implement any subsequent Congressional action while minimizing claims reprocessing and disruption of physician cash flow in the event of legislation addressing the 21% payment reduction,” CMS communicated to the healthcare community in a prepared statement. “Under current law, electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt. As we stated in our recent email to physicians, CMS will provide more information about next steps by April 11, 2015.”

CIPROMS is committed to doing all we can to assist our clients during this waiting process.

  • We are monitoring the actions and announcements of both Congress and CMS and will be submitting claims and processing electronic remittances and payments as expeditiously as possible to ensure continued cash flow for our clients.
  • As well, if new fee schedules are published, we will integrate those into our practice management system quickly so that we can continue to monitor for underpaid or denied claims and issue appeals when necessary.

What can you do?

  • Continue to serve your patients and provide us with the information we need to submit claims on your behalf, as always.
  • While no one expects Congress to allow the 21 percent cuts, CMS may have to enact the reduced fee schedule temporarily if the Senate doesn’t move quickly. Consider talking with your financial institution about the availability of short-term financing in the event CMS holds payments beyond the 14-day window or begins issuing reduced payments, even if they are later paid up to the full fee schedule.
  • Also, you can continue to contact your US Senators to express your views about permanently repealing the SGR.

For more information about the delay, read The Hill’s “Blown ‘doc fix’ deadline leaves Medicare payments in limbo.”

— All rights reserved. For use or reprint in your blog, website, or publication, please contact us atcipromsmarketing@ciproms.com. Photo by Nicolas Raymond via Flickr used with permission under the Creative Commons License.


Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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