The Senate passed the Medicare Sustainable Growth Rate (SGR) repeal late Tuesday, leaving only a signature from President Obama to make it law. The President has indicated that he is eager to sign the bill, which is notable not only for what it includes but for what it does not include—namely, another delay of ICD-10.

The new legislation not only eliminates the annual 21 percent Medicare payment cut that has hung over doctors’ heads since 1997, but also makes value-based reimbursement the new model for Medicare reimbursement. The SGR repeal includes a five percent bonus for providers who receive at least a quarter of their Medicare reimbursement through alternative care models and value-based reimbursement models by 2018. Experts predict that 90% of Medicare will be value-based reimbursement by 2018, a transition that we discussed in a recent blog post.

The bill also has been praised for simplifying the administrative burdens of participating in Medicare’s multiple quality reporting programs.

Many industry watchers feared that the ICD-10 code set implementation would be delayed or permanently eliminated by a clause in the SGR bill, as it was in 2014, but no mention was made of the transition.  No additional delays are expected, which means that the likelihood that the ICD-10 start date will remain Oct. 1, 2015, as scheduled, has increased significantly.

What does this mean to you?

The changes from this bill that will impact your practice include:

  • CMS will stop holding claims, which they have been doing since April 1 in anticipation of passage of the SGR fix bill.
  • The transition to ICD-10 coding is nearly certain now, making it more important than ever for your practice to prepare for the change. Make a plan and begin training your staff.
  • The move to value-based reimbursement means that it’s vital for your practice to understand and comply with CMS quality programs including PQRS and the Value-Based Modifier program.

Fortunately, the SGR repeal bill also consolidates three major quality reporting programs, eliminating some of the redundancies that have frustrated providers attempting to attest for multiple initiatives through various reporting methods with different deadlines.

Multiple industry leaders and medical societies are praising passage of this bill, calling it “historic” and “monumental.” We call it good sense, and long overdue.

To learn more about making the transition to ICD-10 coding in time for the deadline, watch our recent webinar, ICD-10 Success: How to Get There from Here. You can also see free webinars and other resources on PQRS and the Value-Based Modifier in our Resource Center.