Update: Will Congress Fix the Doc Fix?

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Update: Congress To Fix Doc Fix?

Last month, in the closing hours before the Christmas break, Congress voted to freeze the Medicare Physician Fee Schedule at its current level, through the first of March. Had the extension not been granted, practitioners would have been required to absorb a 27% reduction in fees, as dictated by the Sustainable Growth Rate formula (SGR). Congress returned last week. How quickly it will move to address the SGR remains to be seen. 

This issue is important to Chiropractors for a simple reason. If you are PAR, your paycheck could vary wildly this spring, whenever and if ever the Congress acts. If you are non-par, you could be liable for potentially huge fines. 

How is that? PAR providers agree to accept what the government gives them as full payment for claims. If the government changes the rates, they adjust the bill. On the other hand, Non-PAR providers agree to accept the government’s limiting charge, which is a fee the government sets. A non-PAR provider who bills more than the limiting charge is in theory subject to a $10,000 fine per service rendered, and this is what makes the dancing dates so dangerous. 

To illustrate, let’s say that a non-PAR provider renders 20 services to various Medicare patients (generally one visit each) between Valentine’s Day (Feb.14) and the Saturday at the end of that week (Feb 18). The following Monday, President’s Day (Feb 20), no laws change, but let’s say the government decides to enrich itself a little by moving the Physician Fee Schedule downwards the following day, Feb 21 (Fat Tuesday). 

Sadly, your receptionist does not get the memo, and sends out five more claims for your services on Ash Wednesday (Feb. 22), using the old prices. Those five claims could in theory generate about $100,000 in fines! The way out of this mess would be to apologize to your patients, send out letters explaining the error, acknowledging fault, etc., If investigators determine that you were self-correcting via your written compliance program, you just may spare yourself. However, it really isn't your fault, is it. If the government was staying on the beam there would be no difficulties. 

This "bow and scrape" approach is exactly the approach taken by a New York Hospital recently, when it was discovered that its billing firm had inadvertently sent out claims with the invoice number inserted into the box used for the invoice amount. The result was that hundreds of patients received bills for thousands of dollars, even for simple ED visits. It is not certain what the economic fate of the facility will be. According to our consultants, the letter of the law says they are at quite a serious risk.

 

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