Around this time of year wonder if my work will be reimbursed at 30% of what it was the year before or not.  Historically, not.  Actually small raises.  Now tangled up with an oil pipeline...Predict a cut on order of less than 10% if any...

December 20, 2011 — Medscape — The House today voted to reject a Senate bill postponing a 27.4% cut in Medicare reimbursement to physicians from January 1 to March 1, and to try to meld conflicting legislation through a House–Senate conference committee.

The tortured Congressional proceedings increase the odds that the cut will take effect New Year's Day.

The fight is not over physician compensation, but larger issues that have taken it hostage. The drama dates back to last Tuesday, when the Republican-controlled House voted 234 to 193 to approve a 2-year "doc fix" to the Medicare reimbursement crisis that would have given physicians a 1% raise in 2012 and 2013. This provision was a sideshow in a larger bill that would extend a temporary reduction in the Social Security payroll tax for 1 year, continue unemployment benefits for the long-term jobless, and force President Barack Obama to make a decision within 60 days on a permit for the controversial Keystone XL oil pipeline, which the GOP views as a giant jobs creator. The Obama administration had delayed the decision until 2013 to give it more time to study environmental concerns.

The Democrat-controlled Senate answered the House on Saturday by approving a 2-month extension of the payroll tax cut and unemployment benefits, along with a 2-month doc fix. The bill also includes a hurry-up timetable for the pipeline. In contrast to its counterpart in the House, the Senate measure passed with overwhelmingly bipartisan colors in an 89 to 10 vote.

CMS to Suspend Claims Processing in Early January

In tonight's vote, House Republicans followed the lead of House Speaker John Boehner (R-OH), who said earlier today that the Senate's short-term payroll tax cut extension "causes uncertainty for job creators." Tax policy conducted "2 months at a time" is the kind of Congressional decision-making, he added, that "has put our economy off its tracks." Just 2 days before, Boehner had called the Senate bill a "good deal." Democrats attribute his reversal to Tea Party pressure.

The differences over the legislation go beyond the timeframe. Senate Democrats would like to pay for a 1-year payroll tax cut extension and other provisions in part by raising taxes for millionaires. House Republicans prefer offsets such as freezing the pay of federal workers, raising Medicare premiums for high-income beneficiaries, and defunding portions of healthcare reform.

For the time being, Democrats and Republicans are in a holiday season stand-off. Just because the House Republicans voted today to take their payroll tax dispute to a bicameral conference committee does not oblige Senate Democrats to sit down at the table with them. Senate Majority Leader Harry Reid (D-NV) said yesterday that he will not reopen negotiations about a long-term version of the payroll tax cut extension until the House passes the Senate's 2-month deal, forged with Senate Republican leadership at Boehner's request, Reid noted.

This impasse leaves physicians with the prospect of members of Congress going home for the holidays without averting the 27.4% reduction in Medicare reimbursement set for January 1. Congress could postpone it retroactively when it goes back to work on January 17. Anticipating such an outcome, the Centers for Medicare and Medicaid Services (CMS) announced today that it would instruct its claims processing contractors to hold physician claims for the first 10 business days of January, or through January 17.

By putting claims in suspended animation, CMS can avoid paying them at the drastically reduced rate and wait for a more benign rate to kick in. CMS predicts that the interruption will have "minimal impact" on physician cash flow because a correct electronic claim cannot be paid until 14 calendar days after receipt anyway. Organized medicine counters that the CMS hold on claims processing still creates a financial hardship for practices that have payrolls to meet.