Senate Stalls on 'Doc Fix' Legislation - Information Doctors Need Regarding Medicare Payments


There will be no 'doc fix' until at least mid-April. The House passed the legislation (H. R 2), which also includes a two-year extension of the Children's Health Insurance Program, by an overwhelming 392-37 margin on Thursday, and President Obama has indicated that he intends to sign the legislation.

However, on Friday morning (March 27) the Senate adjourned for its spring break without taking up the legislation to permanently repeal Medicare's flawed Sustainable Growth-Rate (SGR) formula for paying doctors. The Senate is expected to take up the measure when it reconvenes on April 13.

By law doctors are to receive 21 percent cuts in Medicare reimbursements for service provided on or after April 1. Under current law, electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt. CMS will notify providers on or before April 11, 2015, with more information about the status of Congressional action to avert the cuts.

Here's what doctors need to know about payments for Medicare services:

  • Technically, payments for Medicare services provided on or after April 1 will be subject to a cut until Congress passes a bill. Claims processed after April 1 for services provided before that date will not be cut.
  • Since electronic claims are not processed for 14 days (paper claims take 29 days), the impact of the cut will not be felt immediately.
  • Congress returns to Washington, D.C. on April 13 and plans to take up the bill promptly, so it is possible that the situation will be resolved before any claims are actually processed at the reduced rate.

Members are urged to contact California's Senators Diane Feinstein and Barbara Boxer and urge them to support H.R. 2 when they get back from their vacation in any of the following ways:

  • Call senators using the AMA's toll-free Physicians Grassroots Hotline at 1-800-833-6354
  • Use APMA's eAdvocacy to send Senators a readymade letter urging their support of the legislation. Under Action Alerts click on the Medicare SGR Reform bullet.  (To retrieve your APMA login please contact APMA Member Services at 800-ASK-APMA.)