December 2006

Congress halts 5% Medicare fee cut

Congress, in one of the final acts of the session, passed legislation that halts a 5 percent cut in Medicare physician fees. The reduction would have gone into effect on Jan. 1, 2007, in addition to the 8 percent cut doctors of chiropractic will incur in February 2007.

Instead, the Tax Relief and Health Care Act of 2006, the omnibus bill that contained the physician fee provision, provides no increase in the congressionally mandated sustainable growth rate (SGR) mechanism which works to hamper spending in the Medicare program. The president is expected to sign the bill.

“The ACA is pleased that Congress has halted this portion of the upcoming cuts in physician Medicare payments,” said ACA President Richard G. Brassard, DC. “It is completely unreasonable to expect providers to take on further financial constraints when they are already being hit from all sides with fee decreases. We applaud this move as a significant recognition of the increasingly stressful environment for physicians in Medicare.”

Although the Tax Relief and Health Care Act of 2006 provides some measure of relief, providers in Medicare still face fee cuts for 2007. Under a final rule — issued by CMS per the congressionally mandated five-year review of the work values of billing codes — doctors of chiropractic will face an average 8 percent cut starting in February 2007. This rule also imposes significant cuts to radiological and imaging services.

The bill also includes a provision that will allow for a 1.5 percent increase in reimbursement for providers who report on existing quality measures established by CMS. Quality measures are developed by several different organizations through a rigorous process grounded in evidence-based medicine. The measures, approved by CMS, are geared toward primary care practices and have been utilized in the Physician Voluntary Reporting Program.

Because the fee schedule has many different components, including a geographic consideration, doctors of chiropractic should contact their local Medicare carriers/contractors for information on what their fees will be in 2007. The 8 percent decrease is only an average and percentages may vary, depending on location.

For most chiropractors — with the exception of those participating in the Medicare Demonstration Project — coverage of chiropractic services is specifically limited to treatment by means of manual manipulation of the spine.

The Tax Relief and Health Care Act of 2006 gives CMS authorization to continue an exception process for Medicare beneficiaries to apply for medically necessary therapy services if their treatment is expected to exceed the cap in 2007.

]Source: ACA Today, American Chiropractic Association, www.acatoday.com

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