Late tonight (April 14, 2015), the
Senate voted on H.R. 2 to repeal and replace the flawed sustainable growth rate (SGR) formula
that is used to determine payment for outpatient services under the Medicare Physician Fee Schedule
(MPFS, this includes outpatient therapy) and extend the outpatient therapy cap exception process
that had expired on April 1, 2015. In addition, Senators Cardin (D-MD) and Vitter (R-LA) proposed
an amendment to permanently repeal the Medicare outpatient therapy caps. Under agreement established
by Senate leadership, the amendment required 60 votes to pass. This amendment would be voted on first
by the Senate before taking a vote on a possible revised H.R. 2 bill.
The results of the amendment vote to completely repeal the Medicare outpatient therapy cap was
58-42, failing by just 2 votes. The Senate then voted on H.R. 2 and passed this legislation by a
vote of 92-8. The bill will now be sent to President Obama who is expected to sign it.
So what does this legislation mean for providers of outpatient therapy services? The therapy cap
exception process will continue until December 31, 2017 and will provide for a 0.5% increase in payment
for services reimbursed under the MPFS instead of the 21.2% reduction that was to go in effect on April
Under current law, electronic claims are not paid sooner than 14 calendar days (29 days for paper
claims) after the date of receipt.
The Centers for Medicare and Medicaid Services (CMS) have been holding claims with dates of service
April 1, 2015 and after. On April 15, 2015, CMS is to begin paying claims with dates of service April
1, 2015 that were received on April 1, 2015. Due to the late passage of H.R. 2, we will have to wait
to see if CMS holds these claims beyond the 14 calendar days to allow their systems to be updated with
the 0.5% increase instead of the 21.2% reduction. As further information becomes available, this story
will be updated.
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