Doc Fix Bill Passed by Congress Will Also Affect ICD-10 Conversion and SNFs
April 1, 2022

As we reported last week the House of Representatives passed a “doc fix” bill on Thursday.  The bill was passed by the Senate yesterday and, after the president’s signature, it will become law today, April 1, 2014.  This new law will override a cut to reimbursements for physician services provided to Medicare beneficiaries under the Sustainable Growth Rate (SGR) formula.  The bill passed the Senate last night after pushback from some senators looking for a permanent repeal of the SGR formula.  In addition to the doc fix, other elements of the new law will affect various areas of the healthcare industry.  Of particular note is a provision that would delay ICD-10 implementation and a provision that would create a value-based purchasing program for skilled nursing facilities (SNFs).  Here is some short commentary of each on these elements:

  • Doc Fix – If the SGR formula had moved forward, it would have resulted in a 24% Medicare payment cut to physicians.  The new doc fix created by this law will last for 12 months.
  • ICD-10 Delay – The Centers for Medicare & Medicaid Services (CMS) had mandated providers to switch to ICD-10 coding by October 1, 2014. Although CMS had stated as recently as last month that they would not be extending the ICD-10 code conversion deadline, the new doc fix law delays that conversion until October 1, 2015.
  • SNF Value-Based Purchasing Program – The law also requires the Secretary of Health and Human Services and CMS to create a skilled nursing facility value-based purchasing program (SNF VBP) by October 1, 2019. The overall intent of such a program would be to take hospital readmission rates into account when determining payment rates to SNFs.  The law states that by October 2018, 2% of Medicare payments to SNFs will be withheld by the government.  The majority of the withheld funds would then be distributed to SNFs that demonstrate lower hospital readmission rates for their patients, creating an incentive program for SNFs.

For more information on these or other topics, please visit our Affordable Care Act Check-Up Site  or contact ParenteBeard Healthcare Partners Lou Feuerstein at Louis.Feuerstein@ParenteBeard.com at 732.388.5211 x12760 or Mark Ross at Mark.Ross@ParenteBeard.com at 570.820.0311.