How MACRA Affects Medicare?

On April 16th, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA CMS reform). This historic Medicare Reform has several very important effects on Medicare.

The legislation permanently repeals the Sustainable Growth Rate (SGR), creates a framework for rewarding clinicians for value over volume,

House Approves Medicare SGR

On March 26th the U.S. House of Representatives passed legislation (with a 392-37 vote) to permanently replace the Medicare sustainable growth rate formula and reimbursement mechanism.  The senate did not review the bill before its 2 week recess.  Mitch McConnell, R-Ky., said that the Senate will act quickly on the legislation when the session resumes on April 13 stating,

Is ICD-10 Dangerous?

Groups including American Medical Association (AMA) and the American Academy of Family Physicians recently wrote to Centers for Medicare and Medicaid Services (CMS) voicing their concerns stating that “the transition to ICD-10 represents one of the largest technical, operational, and business implementations in the health care industry in the past several decades” and arguing that there needs to be industry wide end-to-end testing as the current testing shows results only for a broad overview of claims.

Interoperability – Committees, Issues, and Insights

A draft bill is being circulated among Congress that outlines a plan for achieving interoperability (the ability of any authorized user to read a medical record from any source) by year 2018.  This bill is Rep. Mike Burgess’ (R-Texas) plan to appoint a 12 member committee to help develop standards and stop Electronic Health Record (EHR) software from blocking other interfaces.

CMS ICD-10 Test Gets a Passing Grade

Centers for Medicare and Medicaid Services (CMS) recently conducted a week long test wherein 660 volunteer Medicare fee-for-service providers, clearing houses and billing companies submitted about 15,000 test claims, and Administrator Marilyn Tavenner says CMS is ready.  Of the claims submit 56% were from professionals, 38% were from institutions and 6% were supplier claims.

The goal of the test is to have providers successfully submit claims using ICD-10 codes to the Medicare Fee-For Service (FFS) claims systems,

Meaningful Use Attestation Date Extended

March 20th is now the deadline date set for 2014 Meaningful Use Attestation.  The date was originally set at February 28th, but Centers for Medicare and Medicaid Services (CMS) extended the deadline to allow providers more time to gather and submit their data.  During this extension period, providers an also utilize their one “switch” from Medicare to Medicaid or Vice Versa. 

Eliminating the Gap in Medicare Payments to Independent Doctors vs. Health System Doctors

Last week in the Annual Budget presented by President Obama, the White House asked Congress to “encourage efficient care by improving incentives to provide care in the most appropriate ambulatory setting.” What this means in plain English is that the White House is looking to close the existing gap in payments that Medicare (the government health insurance program for those over 65 or disabled) makes to independent doctors vs.

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