Congress Averts Physician Pay Cut for Six Months, Medicare Participation Deadline Extended until February 15

On December 29, President Bush signed the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173), reversing the projected 10 percent physician pay cut for the first six months of 2008 and replacing it with a 0.5 percent increase in physician payments. The Act also extended the State Children's Health Insurance Program (SCHIP) until early 2009. Now, Congress will have to act again prior to July 1, 2008 to prevent a physician pay cut from going into effect at that time. Democratic Congressmen said Republicans blocked their efforts to pass broader Medicare reforms and view the six-month band-aid fix as a concession.

By providing just a temporary six-month reprieve from the 10 percent pay cut, the legislation passed by Congress leaves the outlook beyond the next six months highly uncertain. In 2008, it is more important than ever to attend the 2008 Urology Joint Advocacy Conference (to be held March 30 - April 1 at the Grand Hyatt in Washington, DC). This meeting will prepare urologists to better advocate on behalf of their practice and their patients. We will need to follow up our efforts by telling Congress in person that they need to fix the SGR and not place needless requirements on the use of ultrasound. Please visit www.uropac.org to register for the conference.

Medicare Participation Deadline Extended
For 45 days at the end of each year, physicians have an opportunity to notify Medicare whether they will be a "participating" or a "non-participating" physician in the coming year. Participating physicians agree to accept assignment on all their Medicare claims. Non-participating physicians can make assignment decisions on a claim-by-claim basis. Medicare payment rates for non-participating physicians are 5 percent lower than payment rates for participating physicians, but non-participating physicians can balance bill patients for more than the Medicare rate, up to a "limiting charge" amount. Physicians also have the ability to "opt out" of Medicare and privately contract with their patients, but neither they nor their patients can submit any claims to Medicare for their services for a two-year period.

As a result of the new law, the Centers for Medicare & Medicaid Services (CMS) reopened the participation decision period for an additional 45 days, with a new deadline of February 15th to file your participation decision. With a 10 percent cut looming in the middle of the year, the participation decision is more complicated. While it is possible that the participation period decision will be re-opened at that time, there is no guarantee. Visit www.ama-assn.org for a document that describes the various Medicare participation options.

Imaging Language Removed from Legislation
The AUA learned that the House and Senate were considering adding a provision to the Medicare legislation that would mandate accreditation of in-office imaging services for advanced modalities and possibly ultrasound. A grassroots ground swell from the urology community put enough pressure on lawmakers that the ultrasound provision was removed and, ultimately, the entire imaging proposal was dropped out of the legislation. Urologists, their staff and patient advocates flooded Capitol Hill with more than 1,000 phone calls in a two-day period. We do not anticipate that this effort will end with the failure of a broad Medicare bill in 2007 but we do believe that this same issue will be considered again in 2008.