CEO Miriam Schwarz, WCMS President Bob Henderson, MD and Diane Hankes, MD (AllCare) went to Raleigh to meet with many of our WNC legislators: Sen. Van Duyn, and Reps. McGrady, Dobson, Turner, Ager, and Fisher to stop the recoupment of 3% of Medicaid funds that have already been disbursed to doctors over the past 14 months.(Click here for background info) We pushed for physician-led ACO's as the solution to Medicaid reform and NOT MCO's. 

Dr. Bob Henderson, Miriam Schwarz, and Dr. Diane Hankes in Raleigh with Rep. McGrady (R-Henderson County) discussing the adverse results of a 3% Medicaid retroactive cut. While we were at the NCGA, we were interviewed by a reporter from NC Health News. Here's the Article: Docs Raise Familiar and New Issues with Legislators

The WCMS Foundation Board of Directors is inviting innovative physicians, practices, and organizations from across the region to present their work to the Board.

The House on 3/26/15 voted 392-37 to approve legislation that would permanently replace Medicare's sustainable growth rate formula. President Obama applauded the bipartisan deal, negotiated by House Speaker John Boehner (R-Ohio) and House Minority Leader Nancy Pelosi (D-Calif.), saying, "This is how Congress should work." Although the current "doc fix" expires at the end of March, Senate leaders said early today that they would not consider the measure until they return from recess on April 13. (Sources: CQ News, 3/26 [Subscription required]; The Hill's "Floor Action," 3/27; Modern Healthcare, 3/26; Modern Healthcare, 3/26; New York Times, 3/26; Politico, 3/26; Reuters, 3/26; Reuters, 3/27; Wall Street Journal, 3/26; Washington Times, 3/26)

From the AMA:

Of course, the current payment patch expires on April 1, long before Congress reconvenes. As a result, all physician services provided on or after April 1 will be subject to a cut of 21 percent. The Centers for Medicare & Medicaid Services (CMS) is instructing its carriers to "hold" for 10 business days any claims for services provided on April 1 and beyond, until legislation can be passed and signed into law that reverses the 21 percent cut. The 10-business-day hold means that April claims will be held through Tuesday, April 14. Since no claims by law can be paid sooner than 14 calendar days from their receipt, this hold should have little practical impact on Medicare remittance in the short-term, although billing for copayments and claims reconciliation will be more complicated.

In the meantime, some practices are asking what they should charge. By law, Medicare is required to pay physicians the lesser of the submitted charge or the Medicare approved amount. For this reason, the AMA is advising against submitting claims with reduced amounts reflecting the 21 percent cut. Instead, we recommend physicians either continue charging the current 2015 rates for April dates of service or defer submitting claims until after final action on the legislation. In the unexpected event that Congress allows the 21 percent cut to take effect, Medicare would pay physicians at the reduced amount no matter what the physician billed and no further action would be necessary. However, non-participating physicians who have collected balance billing amounts for unassigned claims based on the currently-allowed amount could be required to make refunds to their patients based on new, lower balance billing limits.