Recent Legislative Acts Impacting Medicare Payments

By David Wiener posted 01-09-2012 14:57


Dear ASE Members,

Congress and the President agreed to a temporary two month “fix” to the Sustainable Growth Rate (SGR). Without this legislative legislation, physicians faced a 27 percent reduction in Medicare payments beginning this past January 1st.  This bill is a short-term proposal that expires on February 29, 2012. Both chambers will next send negotiators to hammer out a yearlong package.

To afford time for CMS to “reset” its payment programs, on December 19th the Centers for Medicare & Medicaid Services (CMS) instructed all of the Medicare Carriers (Contractors) to hold all 2012 claims for the first 10 business days of January (i.e., January 1, 2012, through January 17, 2012). Medicare claims for services rendered on or before December 31, 2011, will not be affected by the 2012 claims hold and will be processed and paid under normal procedures and time frames. The 2012 hold applies to all claims, not just echocardiography. This is related to the SGR and according to CMS; they will provide an update on or before January 11, 2012, with more information about the status of Congressional action to avert the Medicare pay cut, as well as next steps regarding the claims hold.

All other changes included in the Medicare physician payment final rule for 2012 took effect on January 1st. These changes include the relative value units,  geographic practice cost index (GPCIs), electronic prescribing and quality reporting programs, and multiple procedure payment rules for 2012.  A detailed memo sent to the AMA outlines these changes, some of which are summarized below for your information. A copy of the memo can be found at:


The Physician fee Schedule (PFS) called for the Relative Value Units for TTE with spectral and color Doppler to be reduced by 9% (global); 5% (PC only); 11% (TC only). Please go to for detailed information on the PFS Rule 2012 and to for information on the Hospital Outpatient Prospective Payment System Final Rule 2012.

The Centers for Medicare and Medicaid Services (CMS) did rescind the Multiple Procedure Payment Reduction (MPPR) to group practices. The initial payment cut of 25% to the professional component of second, and subsequent, images of the same patient on the same day for 2012 will not take effect. While echo was not on the initial list of services that would be subject to this reduction, CMS had indicated that it was considering expanding this and other multiple procedure reductions in a way that would impact echo.

Finally, CMS published in the Jan. 4, 2012, Federal Register a correction notice to the 2012 final rule,, that modifies the relative values for a number of services.  The agency also posted to its web site a revised related value file,, reflecting both the corrections and the legislation that stopped the 27.4% cut.

This is a very frustrating and confusing time for all of us in health care, not just for echocardiographers and sonographers. We discussed the disconcerting situation in Washington on last week’s monthly advocacy committee call, but unfortunately there is little we – or the rest of the country – can do while the politics play out. Let’s hope for more directed and productive problem solving from our members of Congress in 2012!