Problems with Version 5010; Updates on the SGR and the RUC

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February 24, 2012
In this issue
» Medicare Billing Snafu Leaves Practices in the Lurch

» Congress Puts Medicare Payment Cuts on the Shelf Till 2013

» ACP Lauds Expansion of Panel That Advises Medicare on Physicians' Work

About this newsletter

The ACP Advocate is an e-newsletter, edited by the College's Washington, DC governmental affairs division, created to provide you, our members, with succinct news about public policy issues affecting internal medicine and patient care. To learn more about ACP's Advocacy and to access the ACP Advocate archives, go to

Welcome to The ACP Advocate

Our first story this week is all about a problem that you may have been experiencing in your practices.  Due to the changeover to Version 5010 standards for electronic billing, many practices have been having their Medicare claims rejected.  More details are in the story, but we believe that as clearinghouses and billing practices adjust to the new standards that the situation will resolve itself shortly.  If you are still experiencing problems we encourage you to report any issues.  To the right of this letter you’ll find a link with instructions for how to submit complaints.
Our next story this issue brings you up-to-date on the latest round of potential Medicare payment cuts due to the SGR.  While the law ensures that a 27.4% cut that had been scheduled for March 1 will not go into effect, Congress once again failed to enact a permanent solution to the SGR.  We will be back in the same position again at the end of the year.  We will continue to hammer in the message to Congress that these short-term fixes are no solution, and that continually fighting this battle distracts us from being able to truly and effectively address the many important issues confronting our health care system.
Finally, our last story this week is all about changes being made to the Relative Value System (RVS) Update Committee (RUC).  For those of you who aren’t familiar with it, the RUC is a panel of physicians that advises Medicare about setting relative values for different patient services, these relative values are then used to calculate payments for CPT codes.  Among the changes, which ACP has been advocating for, are an increase in representation for primary care physicians and support for care coordination services. 
For more coverage of what's happening in Washington, take a look at my award-winning blog, The ACP Advocate Blog by Bob Doherty.  You can also follow me on Twitter @BobDohertyACP

And, as always, please send your feedback and suggestions on this newsletter to:

Yours truly,

Bob Doherty
Senior Vice President
Governmental Affairs and Public Policy
American College of Physicians     


In the news
» Medicare Billing Snafu Leaves Practices in the Lurch
  Physicians urged to contact ACP about problems with rejected claims

Physicians are reporting that a bug-ridden new computer billing upgrade is causing Medicare to randomly reject their claims, putting them in a financial pinch as the federal government scrambles to solve the problem.

The Centers for Medicare and ... » Click to read the full article

» Congress Puts Medicare Payment Cuts on the Shelf Till 2013
  Lack of permanent fix to perennial problem irks ACP and other health care groups

The U.S. Congress has once again delayed implementation of the Medicare sustainable growth rate, heading off a 27.4 percent cut in payments to doctors.

However, postponement of the SGR through 2012 has infuriated many in the health care community... » Click to read the full article

» ACP Lauds Expansion of Panel That Advises Medicare on Physicians' Work
  Adding primary care and geriatrics specialists may improve accuracy and trust

With a nod toward the realm of internal medicine, the American Medical Association has expanded membership on the committee that makes recommendations to Medicare on the resources involved in various types of patient care and the relative value of that wor... » Click to read the full article

In focus
How to Submit Complaints about Medicare Claims Rejections
If you have been experiencing problems with Medicare claims rejections that you believe may be due to the conversion to the Version 5010 standards for electronic billing, we encourage you to submit a report using the AMA complaint form. In addition, practices experiencing problems should be in touch with their billing services or clearinghouses to attempt to resolve the problem.

AIMn Now on Twitter
Get the latest information about the College’s advocacy efforts and the Advocates for Internal Medicine network (AIMn) through a new Twitter feed, Advocates for IM. There you will find the latest information about the activities of the College’s government affairs office and the hot topics in Washington.

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