Energy and Commerce Committee Invite Stakeholders to SGR Meeting

On May 28, NASS staff attended a meeting with House Energy and Commerce Committee staff to discuss the committee’s discussion draft legislation to reform the sustainable growth rate (SGR). Several provider groups capitol webwere in attendance and copies of the discussion draft were circulated to attendees by Committee staff.

During the meeting, staff acknowledged that in its current form, the draft will need to be modified, and urged participants to submit their feedback to the discussion draft legislation by June 10. Staff also noted that Members of the Energy and Commerce Committee have not endorsed this discussion draft with exception to the first section calling for the repeal of the SGR. In addition to repealing the SGR, the legislation proposes the creation of a “Fee Schedule Provider Competency Update Incentive Program,” which would create a process that allows physicians and the Secretary of Health and Human Services (HHS) to develop quality measures sets. The proposal was void of any time tables, for example the period of time it would take to stabilize payments to test measures, and costs associated with repealing the SGR.

Committee staff indicated that a significant education process with Members sitting on the Committee will need to take place, and as a result the Committee will be holding a hearing on this draft on June 5. According to staff, the goal is to have SGR reform legislation introduced and passed by the committee by the end of the summer. The committee is working aggressively to meet this timeline, as the political climate will undoubtedly change once fall arrives and Congress takes up budgeting and debt ceiling matters. Staff indicated that there is a good faith effort on behalf of both Democrats and Republicans in the Committee to replace the SGR and are optimistic that they will reach its goal.

Bill to Delay ICD-10 Implementation Introduced in Senate

On May 17, Republican Senators Tom Coburn (OK), John Barrasso (WY), John Boozman (AR) and Rand Paul (KY) introduced the Cutting Costly Codes Act of 2013, which is aimed at postponing the implementation of the new ICD-10 coding system. In a release, the Senators expressed their concern over the potential increasing cost to physicians to comply with the program. Initially, the program was set to take effect in October 2013. However, the Health and Human Services Department (HHS) delayed implementation for one year. It is estimated that practices would endure $83,000 – $2.7 million in costs (depending on the size of the practice or hospital) to comply.

CMS to Establish New RAC

The Centers for Medicare and Medicaid services are planning to create new Recovery Auditor Contractors (RACs) for durable medical equipment (DME) and home health. Implementation of the new RACs for new contracts for DME/home health awards beginning 2014-2018. CMS has long been concerned about overbilling in these areas, yet RACs have never been utilized to investigate error rates. Industry insiders complain that adding additional RACs will limit RACs abilities to audit overpayments for other providers.

In other RAC news, Senator Roy Blunt (R-MO) introduced S. 1012, a bill to amend title XVIII of the Social Security Act to improve operations of recovery auditors under the Medicare integrity program, to increase transparency and accuracy in audits conducted by contractors to the Committee on Finance on May 22. This bill is the Senate version of a similar bi-partisan bill that Rep. Sam Graves (R-MO) and Rep. Adam Schiff introduced earlier this year.