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Pain Management Coding Alert

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The SGR Formula Will Be History - But ICD-10 Is "Go"

Plus: Payment boosts are coming in July. 

President Obama has signed HR 2 into law, making the Medicare Access and CHIP Reauthorization Act (MACRA) official and bringing important changes to every physician practice. 

On the reimbursement front, MACRA eliminates the SGR formula for Medicare physician payment once and for all. Congress has passed 17 SGR “patches” since 2002, which has made both legislators and physicians wary about simply moving the problem forward yet again.

MACRA gives 0.5 percent annual boosts to your Medicare pay for almost five years starting in July, after which practitioners will get bonuses based on quality of care rather than the number of procedures administered. As for your current payments, you’ll continue to collect based on the rates that were in effect from Jan. 1 through March 31, giving MACs and practices time to prepare their systems for the new payment formulas that will kick in on July 1.

The cost of the plan would reportedly amount to about $200 billion over the next decade, and some of that cost could be passed on to higher-earning Medicare beneficiaries. 

An amendment to the bill included a proposal that would have ended therapy caps, but that amendment was rejected, meaning that physical, occupational and speech therapists will continue to face reimbursement caps for their services.

Medical associations were very pleased with the outcome, allowing doctors to focus on offering patients care rather than continually worrying about payment patches. “Passage of this historic legislation finally brings an end to an era of uncertainty for Medicare beneficiaries and their physicians—facilitating the implementation of innovative care models that will improve care quality and lower costs,” said the AMA’s Executive Vice President and CEO, James L. Madara, MD, in a statement. “Patients will be able to get the care they need and deserve.”

Be ready: There is no further ICD-10 delay stipulation in the legislation this year, which means your practice needs to be ready for the Oct. 1, 2015 implementation deadline. 

Resource: To read the complete text of the bill, visit www.congress.gov/bill/114th-congress/house-bill/2/text

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