By Mike Amery, Legislative Counsel, Federal Affairs, (202) 506–7468, firstname.lastname@example.org
There continues to be a lot of congressional action around Medicare’s Sustainable Growth Rate (SGR) formula repeal and the momentum is building toward a final solution.
I attended a hearing held by the House Ways & Means Health Subcommittee where both Republicans and Democrats agreed on a quality/value framework. The hearing was titled "Developing a Viable Medicare Physician Payment Policy" and, as far as I heard, there was no partisan disagreement as leaders on both sides of the aisle indicated that repealing and replacing the SGR remains a primary focus.
The Senate held a similar hearing in a packed room that included Derek Brandt of our DC staff. It was clear that both sides of the aisle in the Senate also are seeking a real solution to the SGR.
Even with bipartisan agreement, the path forward with SGR is still very cloudy. The AAN has provided suggestions twice to House Republicans since the beginning of the year. The Senate Finance Committee last week asked the AAN and other specialties three specific questions on SGR repeal:
The Academy’s Medical Economics and Management Committee, Government Relations Committee, and Payment Alternatives Team are drafting a response to these questions to ensure that the interests of neurology and patients with neurologic conditions are made a priority. If you have any suggestions for inclusion please feel free to send them to me at email@example.com.
Two weeks ago, I had conversation with House Majority Whip Kevin McCarthy (R–CA) who assured me and several other physician specialty groups that if a bipartisan agreement could be found on SGR that the cost offset for a full repeal would be available.
No one is going to identify where that money comes from prior to an agreement as it would probably sink any deal. But it is very important that the cost of repeal be a reachable number because the question of SGR repeal has never been about good public policy, it has always been about money.
As I reported in CHR in late March, the SGR has been “on sale” after the Congressional Budget Office (CBO) reduced the cost of repeal from $245 billion to $138 in its last report. After the congressional hearings, the CBO announced it would be issuing a re–score of the cost of an SGR repeal. When this news came out, the buzz on the Hill was that momentum would be determined by the number.
The new score saw a small increase from $138 billion to $139.1 billion over ten years.
The momentum continues.
By Daneen Grooms, MHSA, AAN Manager of Regulatory Affairs
Recovery Auditors (RACs) are conducting reviews of claims for TIA, syncope, and seizures. The Centers for Medicare and Medicaid Services (CMS) states that patients who present with TIA, but whose symptoms resolve spontaneously, should be placed in observation status rather than inpatient admission.
The RAC program was developed to identify and recoup Medicare overpayments and underpayments. If the RAC denial is for services provided more than 12 months ago, carriers may not allow resubmission of claims because the time limit has expired. The AAN believes this unduly penalizes physicians and suggests that the timely filing provision be reset to allow submission of claims following a RAC appeal.
The AAN also has learned that CMS revised the RACs’ scope of work to now require:
By Tim Miller, Senior Program Manager, Communications & State Advocacy