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Medicare Payments

The Centers for Medicare & Medicaid Services released the 2014 Medicare Physician Fee Schedule Final Rule, which went into effect January 1.

This good news follows the AAN's aggressive campaign against a proposal to cut EEG reimbursement and other services. The Academy collaborated with medical associations and state neurological societies, helped coordinate lobbying from patient groups, and rallied support from AAN members who contacted Congress to explain how these proposed cuts could ultimately affect our patients' access to receiving neurologic care. AAN members can continue to count on the Academy to fight for fair reimbursement and patience access to neurologic care.

Access the recording of free webinar "Decoding the 2014 Medicare Physician Fee Schedule: Changes That Impact Neurology."

2014 Physician Fee Schedule
AAN Launches Campaign to Stop Proposed EEG Cuts

The AAN is launching a major campaign to prevent proposed reimbursement cuts by CMS to physicians who perform EEG services. Under the latest CMS proposed fee schedule, neurologists who practice in an office setting and bill globally for EEG services could be subject to drastic cuts if a Medicare policy calling for a cap on practice expense values is finalized. The cap affects 200 codes across several specialties.

This proposal is misguided and could be devastating to neurologists and the patients they treat. That is why the AAN is launching a multipronged campaign including:

  • Submitting written comments to CMS explaining why the analysis is flawed
  • Rallying members to make them aware of these proposed cuts and to take action
  • Working with other professional associations and epilepsy patient groups to share the negative impact of these cuts on patients
  • Coordinating with state neurological societies in crafting their message to CMS

We Need Your Help!

On August 21, members will receive an action alert from the AAN asking them to sign a letter to CMS pointing out the adverse effects of this provision on EEG services. Please take 30 seconds to sign the petition so that CMS can understand the magnitude of these cuts.

For more information, contact Daneen Grooms.

AAN Takes a Stand on SGR Repeal Proposal

The recent Medicare Sustainable Growth Rate (SGR) fix postponed a 24.1-percent cut in Medicare physician payments for the next year. This means that the 0.5-percent increase that has been in effect since the start of the year will remain in place though the end of 2014. However, beginning January 1, 2015, payment rates will be frozen at the 2014 rates until the fix expires on March 31, 2015.

Other provisions of the agreement to temporally fix SGR include:

  • A 12-month extension of the geographic adjustment (GPCI) "floor" of 1.0 for physician work in the Medicare fee schedule
  • Delay of the implementation of the ICD-10 diagnosis coding set until October 1, 2015
  • The Secretary of Health and Human Services would have discretion to continue suspending RAC post-payment audits under the "Two-midnight" policy through March 2015
  • Revises the laboratory fee schedule based on market-based private sector rates
  • Adjusts payments for CT equipment that does not meet certain dosage standards and implements appropriate use criteria for advanced imaging services
  • In 2024, adjustments to sequestration's physician cut would increase to 4 percent for the first six months, followed by zero percent for the second six months; this is done to amplify the impact of the cut and generate more savings
  • Read Capitol Hill Report: Special Edition
Sequestration

Medicare fee for service claims with dates of service or dates of discharge on or after April 1, 2013, will incur a two-percent reduction in Medicare payment.

Claims for durable medical equipment (DME), prosthetics, orthotics, and supplies, including claims under the DME Competitive Bidding Program, will be reduced by two percent based upon whether the date of service, or the start date for rental equipment or multi-day supplies, is on or after April 1, 2013.

Beneficiary payments for deductibles and coinsurance are not subject to the two percent payment reduction BUT Medicare's payment to beneficiaries for unassigned claims is subject to the cut.

The sequestration, resulting from the Budget Control Act of 2011, was postponed by the American Tax Payer Relief Act of 2012. The two percent Medicare cut is part of broader cuts, including automatic spending cuts to national defense and other non-defense budget, to eliminate a total of $1.2 trillion from the federal budget over the next decade.

Read the FAQ on Sequestration from the American Medical Association.

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