After the U.S. House of Representatives yesterday overwhelmingly approved a bill to eliminate the flawed Medicare sustainable growth rate (SGR) formula, the U.S. Senate delayed giving its final approval to the bill. Senate leaders said they will wait until after Congress’ two-week April recess to vote on the legislation, citing the government’s ability to delay processing claims that reflect physician payment cuts scheduled to take effect on April 1. Learn what physicians need to know about payments for Medicare services at this time.

The bill would set into motion Medicare physician payment reforms that will support physician practices that serve our nation’s seniors and military families enrolled in TRICARE. President Barack Obama said he would sign the legislation into law, intensifying pressure on the Senate to move the bill forward. Read about the provisions of the bill at AMA Wire®.

By law, doctors are to receive 21 percent cuts in Medicare reimbursements April 1. The government can delay processing the payments until lawmakers return. In a March 24 email from the Centers for Medicare & Medicaid Services (CMS), the administration said it “urges Congress to take action to ensure these cuts do not take effect.”

“However, until that happens, CMS must take steps to implement the negative update,” the email said. “Under current law, electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt. CMS will notify you on or before April 11, 2015, with more information about the status of Congressional action to avert the negative update and next steps.”

Here’s what physicians need to know about payments for Medicare services:

  • Technically, payments for Medicare services provided on or after April 1 will be subject to a cut until Congress passes a bill. Claims processed after April 1 for services provided before that date will not be cut.
  • Since electronic claims are not processed for 14 days (paper claims take 29 days), the impact of the cut will not be felt immediately.
  • Congress returns to Washington, D.C. on April 13 and plans to take up the bill promptly, so it is possible that the situation will be resolved before any claims are actually processed at the reduced rate.
  • The AMA anticipates that when Congress passes a bill, the restored payment rates will be applied retroactively. 

AMA President Robert M. Wah, MD, in a statement said he was “extremely disappointed” that the Senate delayed its vote.

 “Physicians are always working to provide the highest quality of care for their patients and the bipartisan bill passed by the House provides a clear pathway for them to do that,” Dr. Wah said. “We urge the Senate to immediately address this issue upon their return and once-and-for-all lay this destructive issue to rest by building the stable and sustainable Medicare program that our nation’s patients and physicians need and deserve.”

Physicians can contact their senators and urge them to support H.R. 2 when they get back from their vacation in any of the following ways:

  • Call senators using the AMA’s toll-free Physicians Grassroots Hotline at 1-800-833-6354.
  • Send an urgent email to senators reinforcing the need for SGR repeal now.
  • Contact senators directly through their own social media channels.
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