More Than You Are Probably Interested In Regarding The Sequester,The Affordable Care Act, and Physician Payment

I had been wondering why I have not received a notice from CMS that Medicare payments would be cut by two percent starting March 1 due to the sequester. It has become quite common to receive notices of possible cuts considering all the threatened cuts due to the sustainable growth formula which Congress repeatedly circumvents at the last minute. I found out today that the sequester doesn’t begin to affect Medicare payments until April 1. As Medicare routinely holds payments for two weeks, this actually means we will have six weeks for the sequester to be resolved before this becomes an issue.

Of course there are many other problems which will be caused by the sequester, some now and some down the road, and I don’t expect others to be overly concerned about small cuts in physician payment. Still for me this is a headache, not only because of a decrease in payments but because of the accounting headaches should this turn out to be temporary and the balance of the payments are sent at a later date.

We already have another situation causing us to have to receive partial payment and then the remainder at a later date. The Affordable Care Act calls for Medicaid payment for primary care services to be increased to Medicare levels for two years as of his January. Unfortunately what sounds like something simple has turned out to be bureaucratically quite difficult as the federal government has to approve the updated fee schedules from Medicaid programs from all fifty states. As of now, zero states have completed the approval process. This means that we are now being paid under the old fee schedules and will be paid the higher amounts retroactively to January at a later date. Those who understand how cumbersome medical billing is will recognize the nuisance this causes. Hopefully we won’t go through the same problems because of the sequester.

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