Congress Passes One Year SGR “Patch”

Congress has passed H.R. 4203, the “Protecting Access to Medicare Act of 2014,” by voice vote. The bill prevents a 24% cut in reimbursements for physicians treating Medicare patients on April 1, 2014 and replaces it with a 0.5% update (through December 31, 2014) and a 0% update from January 1 until April 1, 2015. President Obama is expected to sign the bill. The bill represents an acknowledgement that the consensus, bipartisan approach to permanent repeal of the SGR formula will not be accomplished this year due to lack of agreement on a package of offsets.

The legislation includes several provisions regarding quality measurement and payment reductions for computed tomography services provided in physician offices and hospital outpatient departments starting in 2016. The language was “borrowed” from the original SGR repeal legislation introduced earlier this year. The bill also borrowed language requiring appropriate-use criteria to be consulted for advanced imaging (this does not include echo, by statutory definition) and prior authorization for physicians who refer an unusually high number of patients for advanced imaging services only.

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