E/M Coding Alert - 2015 Issue 5
SGR Update: Congress Passes A SGR Fix Bill To Avert Formula Driven Cuts
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Article Overview
This article explains the Medicare Access and CHIP Reauthorization Act and the broader payment-policy changes that accompanied the repeal of the Sustainable Growth Rate formula. It is aimed at physicians, emergency medicine providers, and coding or billing professionals who need to understand how the legislation affects Medicare payment updates, incentive programs, and several related federal payment provisions. The article also reviews several policy areas tied to emergency department reimbursement and hospital payment stability.
Why This Topic Matters
The legislation described in the article affected how Medicare physician payment changes were calculated and how multiple incentive and payment programs were structured. It is relevant to providers and revenue cycle staff who track federal reimbursement policy and its downstream impact on emergency medicine and hospital operations.
Article Sections
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Overview of the legislation and payment changes
Introduces the Medicare legislation that addressed the SGR formula and its impact on physician reimbursement. Summarizes the broad payment-policy changes discussed in the article.
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Incentive programs to be combined
Describes the consolidation of current physician incentive programs into a new performance-based system. Covers the categories used to evaluate performance and the general structure of the payment adjustment.
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Other key provisions for emergency medicine
Reviews additional federal payment and coverage provisions discussed as important to emergency medicine. Includes topics affecting geographic payment factors, children’s coverage funding, beneficiary premium adjustments, inpatient payment review timing, surgical package policy, and hospital disproportionate share funding.
What You Will Learn
- How the article frames the Medicare payment legislation and its purpose
- Which physician incentive programs are discussed in the context of consolidation
- What broad reimbursement and coverage policy areas are addressed for emergency medicine
- Why several federal payment provisions may matter to emergency department providers and hospitals
Who Should Read This
- Physicians
- Emergency medicine providers
- Medical coders
- Billing and revenue cycle professionals
- Hospital administrators
- Compliance staff
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