This Week – March 29, 2014

This Week in Washington DC:

  1. House Passes Another Short-Term SGR Patch
  2. Please Contact Congress: ACG Working to Promote Transparency and Protect GI Reimbursement

House Passes SGR Cut Moratorium Through March 2015

On Thursday, March 27th, the House of Representatives passed a stopgap to looming Medicare provider cuts due to the sustainable growth rate (SGR) formula. This “patch” would avert the 24% cut that was scheduled for April 1st. Instead, Medicare providers will receive a .5% increase through December 2013, then a 0% update from January 2015 to April 2015.

The Senate is scheduled to take up the same bill on Monday, March 31st.

CMS has instructed the Medicare Administrative Contractors to hold claims under Medicare physician fee schedule for the first 10 business days of April (i.e., through April 14, 2014). This hold would only affect claims with dates of service of April 1, 2014, and later.

In one of the strangest “votes” in recent history, House Leadership (both Republican and Democrat) agreed to quickly pass this bill without the members actually casting a vote. While these types of “voice votes” are common for noncontroversial items, it is unclear whether the majority of Republicans and Democrat members in the House actually supported the legislation. In fact, there were reports of the rank and file House members not even aware of this voice vote when it occurred, so there was no opportunity to object on the House floor. ACG joined other medical societies in urging House members to oppose this bill and will continue to demand permanent SGR repeal without offsetting the costs of this repeal from issues important to clinical GI and patients, including traditional GI services as well as ancillary services tied to a GI practice.

Other highlights from this bill:

  • 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 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.

It is vital that CMS announce reimbursement cuts earlier in the process to allow stakeholders ample time to adequately analyze and appropriately comment on pending changes before final cuts are made. Earlier publication of reimbursement changes will afford our societies more time to educate physicians and policy makers about changes in reimbursement that could affect their business operations and health care services.

Increased transparency is an important step in reversing upper GI cuts and preparing for potential cuts to lower GI procedures, which we won’t be aware of until CMS announces policy changes in the payment regulations. Dr. Cassidy’s letter will afford all specialty societies more time to analyze and respond appropriately with data to CMS’ proposed reimbursement determinations, or would help garner more congressional support if CMS chooses to wait until November again to announce significant payment changes.

This is even more important now that Congress will likely expand CMS’ authority under the “misvalued code” initiative.

Thank you for lending your voice to this very important effort.

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