AAFP, Medical Organizations Fight for Medicare Money Due Docs

December 21, 2010 05:05 pm News Staff

As 2010 draws to a close, physician organizations around the country, including the AAFP, are fighting to ensure their members receive retroactive Medicare payments due to them. In a Dec. 9 letter to HHS Secretary Kathleen Sebelius, a number of these organizations point out that CMS has yet to provide retroactive payment increases for 2010.

"We, the undersigned organizations, urge the administration to take the necessary steps to immediately reimburse physicians for the payment changes that are outlined below," says the letter. The correspondence was coordinated by the AMA and signed by the AAFP and scores of other physician organizations, including medical societies from all 50 states and the District of Columbia.

Language in the Patient Protection and Affordable Care Act -- as well as corrections made in the final 2010 Medicare physician fee schedule -- resulted in payments that are retroactively owed to physicians. Specifically, the Affordable Care Act implemented six provisions that call for CMS to reimburse physicians retroactively back to Jan. 1, 2010.

Of particular interest to family physicians, CMS is directed to extend the 1.0 work geographic practice cost index, or GPCI, floor that expired on Dec. 31, 2009, and raise practice expense GPCIs in low-cost areas by reflecting only half the geographic wage and rent cost differences in their calculation.

The letter pointed out that more than 40 states were affected by the GPCI increases. Some of the most significant increases occurred in North Dakota (7.0 percent); Montana (6.7 percent); Wyoming (6.4 percent); Mississippi (5.9 percent); West Virginia (5.6 percent); Kentucky (5.2 percent); and Kansas (4.6 percent).

CMS also is required by law to

  • increase payments for bone density tests,
  • extend the 5 percent add-on payment for specified psychiatry services,
  • extend the therapy cap exception that expired on April 1, and
  • extend a provision allowing independent labs to bill for the technical component of physician pathology services.

"Failure to reimburse physicians for these retroactive payment changes comes on the heels of an extremely disruptive year for our patients," wrote the organizations. "Throughout 2010, Congress enacted short-term, stop-gap measures (to forestall Medicare payment cuts) for durations as short as one month."

The letter calls the payment uncertainties in 2010 due to threatened cuts in Medicare physician payments "highly disruptive" and says that some practices were forced to take out loans to meet payroll and other expenses.

The organizations point out that the recently passed Medicare and Medicaid Extenders Act of 2010(frwebgate.access.gpo.gov) included $200 million to enable CMS to process the retroactive pay increases, and they urged CMS to act immediately to do so.


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