This Week – April 5, 2014

This Week in Washington DC:

  1. Short-Term SGR Patch Signed into Law
  2. ACG Provides Comment to Medicare Proposed HCV Screening Policy
  3. Medicare to Release Provider Level Reimbursement Data to Public
  4. Contact Congress Today and Urge Them to Sign the Cassidy Letter!

Medicare Providers SGR Cut Moratorium Through March 2015

On Tuesday, April 1st, President Obama signed into law the Protecting Access to Medicare Act of 2014.

Last week, the House of Representatives passed this stopgap to looming Medicare provider cuts due to the sustainable growth rate (SGR) formula. This “patch” averts the 24% cut that was scheduled for April 1st. Instead, Medicare providers will receive a .5% increase through December 2014, then a 0% update from January 2015 to April 2015. The Senate passed the same bill on Monday, March 31st.

ACG joined other medical societies in urging Congress to oppose this bill (view letter) and will continue to demand permanent SGR repeal without offsetting the costs of this repeal from issues important to clinical GI and patients, such as traditional GI services as well as ancillary services tied to a GI practice.

Other “Protecting Access to Medicare Act of 2014” highlights:

  • Expands CMS’ authority to review the valuation of medical codes in Medicare Part B. Unfortunately, ACG members have become all too familiar with this “misvalued code” initiative review. This could impact other GI services and there is no “grandfather” clause for GI services that have recently gone through this auditing process.
  • Delays ICD-10 implementation one year, meaning providers would begin using ICD-10 diagnosis codes in October 2015 instead of October 2014.
  • Extends the Medicare work Geographic Practice Cost Index (GPCI) floor for 1 year.
  • Authorizes CT equipment radiation dose standards for procedures such as CT colonography.
  • Extends the Medicare “two midnight” rule when determining whether a Medicare beneficiary is out-patient vs. in-patient.
  • Seeks to align Medicare payments for clinical diagnostic laboratories and tests with private payors by requiring labs to report private reimbursement for such tests.   

ACG Urges CMS to Expand HCV Screening in Medicare

On Thursday, April 3rd, ACG submitted comments in response to Medicare’s proposed decision memo for screening for Hepatitis C Virus (HCV). CMS released this proposed decision last month, providing that Medicare will cover an HCV screening test ordered by the Medicare beneficiary’s primary care physician or practitioner within the context of a primary care setting, and for beneficiaries who meet either of the following conditions.

  • A screening test is covered for adults at high risk for HCV infection. “High risk” is defined as persons with a current or past history of illicit injection drug use; and persons who have a history of receiving a blood transfusion prior to 1992. Repeat screening for high risk persons is covered annually only for persons who have had continued illicit injection drug use since the prior negative screening test.
  • A single screening test is covered for adults who do not meet the high risk as defined above, but who were born from 1945 through 1965.

ACG commended CMS for covering routine as well as age-based screening, but also urged CMS to expand the list of eligible providers who may order an HCV screening test. While any Medicare provider can do the screening under this proposal, the decision as written limits the type of clinician (and setting) who can order the test. Instead, the proposal would require the beneficiary to get a referral if a GI clinician were to perform the screening. ACG believes this policy is counter to the goal of screening an entire birth-cohort in order to find those millions of high-risk and asymptomatic Medicare beneficiaries living with chronic HCV. ACG also reminds CMS that many GI clinicians serve as primary care physicians in their communities. CMS should focus on the provider’s services and not the specialty designation. The GI clinician is also an expert in the importance of HCV screening, the natural history of the disease, as well as available therapies. Please read ACG’s comments here.

ACG will continue to advocate on behalf of GI clinicians and patients. ACG will also continue to update membership on CMS coverage determinations.

CMS to Release 2012 Medicare Reimbursement Data This Month

CMS announced on Wednesday, April 3rd, that it would release billing information on more than 880,000 Medicare providers in the Medicare’s Part B fee-for-service program. The data will be released to the public by April 9th. The data will include provider-level information on services delivered in 2012, such as: the number and type of health care services, the health care setting, the number of unique beneficiaries treated, average submitted charges, and the average amount Medicare paid for those services.

As background, a federal judge in Florida in June 2013 lifted an injunction that had been put in place since 1979 on publishing these types of Medicare reimbursement information. Dow Jones & Co. Inc. challenged the injunction.

ACG remains very concerned about the impact of releasing such data without qualifying or conditional statements. There is also no process by which physicians can verify and refute the data before being released for public consumption. ACG also remains concerned about the potential impact to reimbursement in the private payor market.

ACG Members: Contact Congress Today and Urge Them to Sign the Cassidy Letter!

ACG and the GI societies continue to fight significant cuts to the 2014 Medicare reimbursement rates for upper GI endoscopy services. The societies are disputing the validity of the cuts, which CMS announced last year just weeks before they went into effect, without the opportunity for public comment.

The GI societies have engaged the help of Congress to avoid future eleventh hour changes to our reimbursement. It’s critical that we improve the transparency of a process that impacts millions of Medicare beneficiaries and practices across the country.

Representative Bill Cassidy, MD, FACG (R-LA) has asked his House colleagues to join him on a letter to CMS requesting that the agency make reimbursement decisions in a transparent manner. Colonoscopy codes are currently under review for 2015, so the stakes are high.
We need your help! Contact your representative and urge them to sign on to this letter.

Please stay tuned for further updates. Please also share and discuss your thoughts with fellow ACG members on the ACG GI Circle. To login and share your comments, go to and sign in as a member. Once you have done so, click here and then click the orange "Visit ACG GI Circle" button to be taken to the GI Circle site. If you have not yet activated your ACG GI Circle account, please email us at

Contact Brad Conway, VP Public Policy, with any questions or for more information.

Brad Conway