Supreme Court Decision Put Medicare Bonuses at Risk

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Count regular, run-of-the-mill payments from Medicare as the next ‘what-if’ if the U.S. Supreme Court rejects the Affordable Care Act of 2010 (ACA) in whole or in part.

Included in those broad strokes of uncertainty are quarterly bonus payments the Centers for Medicare and Medicaid Services (CMS) make to practitioners in Geographic Health Professional Shortage Area designations.

In case you are unaware, a May 3 article from the Associated Press quoted Dr. Donald Berwick, former Centers for Medicare and Medicaid Services administrator, saying that so much has changed in the past two years since the ACA was enacted, that throwing-out even portions of the law could cause delays and errors. The Associated Press also interviewed Tom Scully, former CMS Administrator in the Bush administration, who disagreed with Berwick.

Whether there are problems or not, uncertainty is always unwelcome with Medicare payments to healthcare providers. The Associated Press avoided diving deeply into details of the issues and programs involved, but the 10-percent Medicare bonuses paid to physicians in a Geographic HPSA as well as 20-percent bonuses to qualified surgeons and primary care providers are all based on CMS billing and could be affected if there are changes in the healthcare bill’s structure.

HPSA Acumen staffers who have researched the issue say the best advice available to practitioners and billing offices is to keep close track of Medicare billing records and quickly flag payments that do not match local records or expected amounts.

The extra diligence is important now, before the Supreme Court hands down a ruling and immediately afterward, so offices can catch payment errors more easily. But even more importantly, the Associated Press openly speculated that CMS might have to refund the difference between Medicare payments reduced by ACA in the past two years and what they would have been before ACA.

If that is even a possibility, the potential refund amounts would be astounding, not to mention the additional paperwork involved – meaning good record keeping would be even more important to possibly substantiate higher payments for claims since 2010.

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