Lawmakers Head Home for the Holiday, Leaving 21 Percent Medicare Pay Cut in Tact

Lawmakers infuriated doctors groups Friday after failing to act -- again -- on the pending 21 percent Medicare pay cut for physicians.

With the cuts slated to take effect June 1 for doctors with Medicare patients, the Centers for Medicare and Medicaid Services notified physicians it will delay processing claims for two weeks. The CMS ordered contractors to hold claims for 10 business days, essentially halting the pay cut for now. The agency is hoping that by delaying claims, it will give Congress breathing room to agree on delaying, or perhaps repealing, the current Medicare SGR pay formula.

In a letter to its providers, CMS told contractors to hold claims for Medicare reimbursement “to avoid disruption in the delivery of health care services to beneficiaries and payment of claims for physicians.”

Doctors groups immediately voiced their disgust with Capitol Hill. “For the second time this year, members of Congress went home for holiday vacations, parades and rallies without taking action they knew was needed to prevent a Medicare meltdown,” according to a statement by the American Medical Association. “And, for the third time this year, the 21 percent payment cut scheduled for 2010 will have to be stopped after-the-fact.”

The AMA said that when Congress returns from vacation on June 7, lawmakers will likely vote on another temporary patch -- this time expected to last for 19 months. The new proposal being considered by Congress would provide payment updates of 2.2 percent for the remainder of 2010, and an additional one percent increase in 2011, the AMA stated. But if lawmakers don’t act, AMA noted, in 2012 the SGR formula will kick in and payments will be cut by an estimated 33 percent.

So, what happens if the 10 business days pass and no move is made to further delay or repeal the SGR cut? Will CMS again step in to delay claims? Will physicians finally be forced to face the 21% Medicare pay cuts?

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