“Finally Friday!” H.R.2 fixed SGR, but what did it break?

FRIDAY April 17, 2015:

H.R. 2 fixed SGR:

But what did it Break?

What else did that darn bill effect?

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I'm really not sure about this bill. Will it blow up in providers' faces?

I’m really not sure about this bill. Will it blow up in providers’ faces?

I personally watched seven hours of C-SPAN Live coverage of the Senate floor, beginning at 2pm ET, Tuesday, April 14, hoping to see H.R.2 pass with no problems. After a couple of close calls, it finally passed at 930pm ET with no amendments, clearing the way for the President’s signature, finally replacing the SGR formula.

So in that city, the 18th time is a charm, eh?

After reporting on the vote and some notices by CMS the next morning, however, I began to pay more attention to what replaced the SGR formula, as well as some of the other changes that the bill wrought on providers. Hence… this week’s show.

One of the big questions concerned the programs that limit how much Medicare will pay for outpatient therapy services. These limits, known as “therapy caps,” were established in the same bill that created the SGR, the 1997 Balanced Budget Act (PL 105-33). In 2006, Congress created a “temporary” exceptions process, and kept extending that process. However, the current extension ran out, just as the SGR did. But rather than fixing the caps and exceptions outright, and also to avoid yet another reason to oppose the bill, another extension was granted, instead. (This is called “compromise”… something our form of government was founded upon, and Congress has evidently only recently re-discovered.)

Nancy Beckley, MS MBA CHC is a frequent speaker at the local and national level in compliance and rehabilitation.

Nancy Beckley, MS MBA CHC is a frequent speaker at the local and national level in compliance and rehabilitation.

All this (sans the political commentary, we promise) will be discussed by a true expert on these Therapy Caps, Nancy Beckley, President of Nancy Beckley & Associates, of Milwaukee, Wisconsin.

Nancy will reveal:

  • the Therapy Caps exceptions process extension,
  • Manual Medical Review by the RACs,
  • MIPS: the replacement for the SGR formula… for now…
  • doing those pesky ABNs correctly, and
  • proper use of ABN modifiers.

We will also briefly review the post-2018 effects of the MIPS (Merit-based Incentive Payment System) program — only briefly because (1) it’s confusing [go figure], (2) it would take an hour by itself, and (3) a significant part of the program is yet to even be designed. Hence… it takes effect in 2019.

Be sure to listen in and join the discussion!

Handouts for This Week's Show

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REPLAY of This Week's Show

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