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UNDERNEWS

Undernews is the online report of the Progressive Review, edited by Sam Smith, who covered Washington during all or part of ten of America's presidencies and who has edited alternative journals since 1964. The Review, which has been on the web since 1995, is now published from Freeport, Maine. We get over 5 million article visits a year. See prorev.com for full contents of our site

February 27, 2010

MEDICARE PAYMENTS TO DOCTORS TO BE CUT 21% DUE TO SENATE INACTION


NAPLES NEWS - Physicians left their practices Friday frustrated at their elected leaders in Washington for failing to reverse a 21 percent Medicare payment reduction that will now take effect Monday.

The fallout is physicians may scale back on the number of Medicare patients they treat and some may drop out of the Medicare program entirely.

The payment cut likewise applies to members of the military on the federal government's TRICARE insurance.

Physicians have been on pins and needles for sometime over the Medicare payment cut and they didn't expect it would go through because of extensive lobbying and historically, Congress has reversed the cut in prior years.

A reimbursement cut, of a varying amount, from Medicare is expected annually with the start of the new fiscal year on Jan. 1 but Congress usually acts in time to reverse it. In the final days of the session last year, Congress only postponed the 21-percent cut for this year to March 1.

At issue is what physicians and the American Medical Association say is a flawed formula, called the sustainable growth rate, that sets an annual target for Medicare spending on physician services.

After the Senate Friday failed to act and delay again the overall physician cut, which the House did on Thursday, the Centers for Medicare and Medicaid, CMS, notified contractors to hold off processing Medicare claims from physicians for 10 days.

The move to sit on the claims is similar to action taken in 2008 when the Medicare cut of 10.6 percent that year went into effect before Congress later froze it. The pending claims then did not have to reflect the 10.6 percent cut.

Unless Congress reverses the 21-percent payment reduction in the near future, some physicians may reduce the number of Medicare patients they see or opt out of Medicare entirely. A third option is accepting Medicare patients but not participating in the Medicare program, he said. In that case, the physician bills the patients but not more than 15 percent above what they would get from Medicare, he said.

If a physician decides to opt out of Medicare entirely, the physician can charge what he or she wants and the Medicare patient pays the doctor and seeks to be reimbursed from Medicare, Gauta said.


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