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Capitol Hill Report: After SGR, What's Next?

APRIL 7, 2014

by Michael J. Amery, Esq., Legislative Counsel

After SGR, What's Next?
I hope you got a chance to see our recap last week on the SGR patch. On April 1, President Obama signed the legislation preventing a 24.1-percent cut in Medicare payments from taking effect on April 1, 2014.

With SGR on the sidelines for at least a while, we have pivoted back to the issue of policies that promote primary care but fail to include cognitive physicians like neurologists.

I had dinner last week with Rep. Steve Stivers (R-OH), who is the author of our legislation, HR. 1838, that would add neurology to the Medicaid bump portion of the Affordable Care Act. With the bump that pays many providers Medicare rates for the Medicaid patients expiring at the end of the year, we expect a significant push by primary care to have the provision extended. HR. 1838 would add neurology.

We are grateful that Stivers is committed to ensuring that neurology be included in any efforts to extend the bump. HR. 1838 currently has 44 House co-sponsors. The Senate companion bill by Sens. Amy Klobuchar (D-MN) and Susan Collins (R-ME) has five co-sponsors.

I also spoke before the Medicare Payment Advisory Committee (MedPAC), which is a congressional advisory committee on Medicare policy. MedPAC has been a big supporter of moving resources into primary care. I hope you will take a look at my comments, which focused on the need for recognition of cognitive care providers in efforts to improve the practice climate for primary care providers.

This week Bruce Sigsbee, MD, FAAN, and I will be meeting with the White House staff for Medicare policy to discuss the Medicaid bump which was included in the President's FY2015 budget as a one-year extension.


Regulatory Corner
by Daneen Grooms, MHSA, Regulatory Affairs Manager

17th SGR Patch Delays ICD-10 and RAC Review of Two-midnight Rule 
On April 1, the President signed the 17th Sustainable Growth Rate (SGR) patch Protecting Access to Medicare Act of 2014 into law, which means that Medicare payments to physicians will not be cut by 24.1 percent. In addition, the bill also delays the implementation of ICD-10 until at least October 1, 2015, and authorizes the Secretary of the Department of Health and Human Services to continue to suspend Recovery Auditor (RAC) audits of inpatient claims under the "two-midnight" policy.

  • While the AAN supported the October 2014 adoption date of ICD-10, we recognized that there was still uncertainty with respect to vendors' systems being fully tested and ready to process ICD-10 claims on October 1. In fact, we shared our concerns with the Centers for Medicare & Medicaid Services (CMS) last month. On one hand, we are aware that a sizable portion of our membership has been working hard to prepare for the October 2014 implementation date and has invested significant time and resources so that their practice was ready for the transition. Another delay is certainly not what they were expecting and it is unclear how their practice will be affected. On the other hand, we have also heard members say that they support the delay because it will give them more time to prepare for ICD-10 as they are simply not ready.

For neurologists who treat patients with TIA or seizures, you are likely aware of CMS' two-midnight rule for inpatient admissions. As of October 2013, physicians should admit as inpatients Medicare beneficiaries they expect will require two or more midnights of hospital services, and should treat most other beneficiaries on an outpatient basis. Although this policy went into effect last October, RACs have not been authorized to review inpatient claims using the two-midnight rule, which has been welcomed by the provider community. What Congress has done through this bill is extend the moratorium; RACs cannot review inpatient claims regarding a patient's inpatient status through March 31, 2015. RACs, however, can audit inpatient claims for coding and for the medical necessity of a surgical procedure.

AAN, CMS Meet to Discuss Advanced Care Planning
Neurologists are currently having lengthy conversations with patients who require complicated advanced care planning with no compensation. Last Thursday, Dr. Farrah Daly and I participated in a meeting with CMS officials, along with other members of the advanced care planning work group, to present a proposal requesting that CMS provide reimbursement for these services in 2015. We explained that these conversations are planned so that the physician will have the dedicated time to discuss the advanced care planning with patients who have a significant illness with deteriorating medical conditions, and have family and psychosocial issues that must be resolved. While this service can be furnished at the time of an E/M visit, it can also be performed as a stand-alone service without an E/M. This meeting gave us an opportunity to explain why this service is so valuable to the Medicare population and to also hear CMS' concerns so that we can address them in the future.

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