Legislative Update
The UMGMA strives to keep its membership involved and abreast of current legislative issues affecting medical practice management.
Legislative Liaison - Scott Barlow, Central Utah Clinic.
(Articles below reprinted by permission from MGMA Washington Connexion)
Medical Group Management Association, Government Affairs Department.
www.mgma.com, govaff@mgma.com
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CMS instructs carriers to temporarily hold claims Over the weekend, the Centers for Medicare & Medicaid Services (CMS) instructed carriers to temporarily hold claims. In its statement, CMS said: “To the extent possible, CMS wants to work with Congress, health care providers and the beneficiary community to avoid any disruption in the delivery and payment of physician and nonphysician practitioner services beginning on July 1. In this regard, the agency plans to instruct its contractors to not process any physician and nonphysician practitioner claims for the first 10 business days of July. Under current law, electronic claims are not to be paid any sooner than 14 days (29 days for paper claims) and not later than the 30th day they are submitted (otherwise, CMS must pay interest on those claims). By holding claims for health care services that are delivered on or after July 1, CMS will not be making any payments on the 10.6 percent reduction until July 15, at the earliest. Meanwhile, all claims for services delivered on or before June 30 will be processed and paid in regular order.” The Medical Group Management Association (MGMA) is concerned this is a largely symbolic gesture to mitigate the negative provider and public response to the Administration’s veto threat over H.R. 6331 (see below). Regardless of the outcome of Congressional action, there is high probability that practices will experience claims processing delays throughout the month of July. CMS has indicated to MGMA that further information will be forthcoming. MGMA will continue to monitor the situation and provide updates as available. Senate to vote again on H.R. 6331, continue calling your senators The Senate leadership has indicated when Congress reconvenes following the July Fourth recess, the Senate will vote again on legislation to retroactively fix the 10.6 percent cut that takes effect July 1. It is therefore extremely important for MGMA members to call their senators and urge they immediately pass 18 months of positive updates. The Medicare Improvement Act for Patients and Providers (H.R. 6331), supported by MGMA, would halt the scheduled 10.6 percent cuts in physician payment scheduled for July 1 and the projected 5 percent cut for 2009. The bill would continue the 0.5 percent payment increase for 2008 and provide an additional 1.1 percent increase for 2009. MGMA is coordinating our grassroots efforts with the American Medical Association and physician specialty societies and ask that you please use the unified grassroots hotline at A number of senators have attempted to justify their prior* “no” votes on H.R. 6331 based on Medicare patient access and other concerns. The White House has also threatened a veto using the same rationale. MGMA strongly supports the Medicare Advantage provisions in H.R. 6331. Please use the following information to counter the political messaging of the administration and senators who oppose the bill. Myth: H.R. 6331 would restrict access to Medicare Advantage Plans. Fact: The “deeming” reforms included in H.R. 6331 apply only to fee-for-service Medicare Advantage plans in states where other plans have already established physician networks. Currently, physicians in such states are automatically deemed to be part of a network and are bound by a plan’s terms and conditions whenever they care for a private fee-for-service patient--even those physicians who have never seen or signed a contract informing them of the plan’s requirements. H.R. 6331 would not put these private fee-for-service plans out of business. Rather, the bill would give these plans two years to establish bona fide physician networks and, importantly, put them on an even playing field with other Medicare Advantage plans—including HMO, PPO, and network-based MSA plans--that have already gone through the network development and contracting processes. Those rural areas where physician networks are difficult to establish and beneficiaries are served by only one Medicare Advantage plan would not be affected by H.R. 6331. Myth: H.R. 6331 would restrict competition. Fact: By leveling the playing field between fee-for-service and other types of Medicare Advantage plans, and by making all plans adhere to the same contracting and network development requirements, H.R. 6331 actually enhances competition. The bill eliminates the unfair marketing advantage currently enjoyed by fee-for-service plans in states where other Medicare Advantage products exist. Myth: The deeming provisions in H.R. 6331 would cut payments to Medicare Advantage plans. Fact: The program savings achieved by the deeming provisions would not result from payment cuts. Rather, by applying a consistent set of networking and contracting rules across all plans, the current rapid rate of enrollment growth in private fee-for-service plans will be reduced in non-rural areas where other Medicare Advantage plan choices are available. *See how your senator voted on prior H.R. 6331 vote. FOR IMMEDIATE RELEASE June 30, 2008
CMS PROPOSES PAYMENT, POLICY CHANGES FOR PHYSICIANS’ SERVICES IN 2009
PROPOSED REGULATION PROMOTES HIGHER QUALITY, EFFICIENT CARE
The Centers for Medicare & Medicaid Services (CMS) today proposed new efforts to promote access to higher quality and more efficient health care delivered by the nation’s physicians to people with Medicare under the 2009 Medicare Physician Fee Schedule (MPFS).
“We are taking a multi-pronged approach to improve how Medicare pays for health care services for our nation’s seniors,” said CMS acting administrator Kerry Weems. “These efforts are designed to ensure that beneficiaries continue to get the highest quality of health care at the greatest value for beneficiaries and the Medicare program.”
The MPFS was created by Congress and is updated annually to set the Medicare payment rates for more than 980,000 physicians and nonphysician practitioners (NPPs) who bill Medicare for the services they furnish to beneficiaries. Under a formula in the Medicare statute, CMS is required to reduce 2009 Physician Fee Schedule by 5.4 percent. Total Medicare spending under the 2009 Physician Fee Schedule is projected at $54 billion, down 5 percent from the $57 billion projected for 2008.
Nearly 95 percent of physicians enrolled in Medicare accept the fee schedule rate as payment in full. Medicare pays 80 percent of the fee schedule rate, while the beneficiary is responsible for the remaining 20 percent.
“CMS has been carefully monitoring beneficiary access to physicians’ services,” said Weems. “To date, our studies, as well as studies by the Medicare Payment Advisory Commission, reveal that beneficiaries in most areas of the country are having little or no trouble in seeing their physicians and we expect this to continue in 2009.”
Through the MPFS, CMS is encouraging greater efficiency in the delivery of care, while reducing treatment errors through the use of electronic health records; and exploring new payment models to see if there are ways to promote greater coordination of care among providers, producing better outcomes for the health care dollar.
CMS is proposing additional improvements to the Physician Quality Reporting Initiative (PQRI) which allows eligible professionals to report quality measures relating to their clinical practice. Proposed changes for the 2009 PQRI Program include:
· Proposing that the final set of quality measures will be selected from 175 measures that fall into four broad categories: (1) 113 current 2008 PQRI measures; (2) 17 new measures that have been endorsed by the National Quality Forum (NQF); (3) 20 new measures that have been adopted by the AQA Alliance (AQA); and (4) 25 new measures proposed for 2009 contingent on NQF endorsement or AQA adoption by July 31, 2008; · Increasing the number of conditions covered by measures groups to nine, adding coronary artery disease, HIV/AIDS, coronary artery bypass surgery, rheumatoid arthritis, care during surgery, and back pain, to the original measures groups for diabetes, chronic kidney disease, and preventive care. Measures groups require reporting a set of related measures and can help assure that patients are receiving a range of care appropriate for a given clinical condition or clinical focus. · Reporting options that include two new reporting periods (January 1, 2009 to December 31, 2009, or July 1, 2009 to December 31, 2009) to provide eligible professions with additional options for reporting PQRI data; and · Accepting PQRI data via clinical registries and electronic health records systems.
Launched in 2007, the PQRI was recently expanded as a result of the Medicare, Medicaid and SCHIP Extension Act of 2007 to include additional measures that will allow more eligible professionals to earn incentive payments in 2008 for submitting 2008 data, and to provide alternative, streamlined methods for reporting. Thus, eligible professionals who are not already participating in the PQRI this year will have the opportunity to begin reporting in July 2008 to qualify for an incentive payment. Those eligible professionals who have reported PQRI data successfully for the full year can earn an incentive payment based on their total Medicare allowed charges for services furnished in CY 2008, while those who begin reporting in July can earn an incentive payment based on their total allowed charges from July 1 through December 31, 2008.
CMS is also proposing to improve the quality of diagnostic testing performed by physicians and NPPs in their offices by requiring them to enroll as suppliers of these services and to meet certain quality and performance standards, including applicable Federal and State licensure, health and safety requirements that currently apply to independent diagnostic testing facilities (IDTFs). CMS is proposing to make the standards effective January 1, 2009 for newly enrolling suppliers, but to allow existing suppliers until September 30, 2009 to come into compliance. The proposal specifically seeks public comment about whether these standards should apply to all diagnostic services or to a subset of services such as those that require more costly testing and equipment, imaging services generally, or only advanced imaging techniques.
The fee schedule proposed rule also addresses a change to the exemption that limits the use of computer-generated faxes to e-prescribe Part D covered drugs for Part D eligible individuals to instances in which temporary/transient transmission failure or communication problems preclude the sue of the adopted NCPDP SCRIPT standard. This change is scheduled to take effect on January 1, 2009.
In the MPFS 2009 Proposed Rule, CMS is proposing to retain the provisions that would allow for use of computer-generated faxes in instances of temporary/transient transmission failure or communication problems that preclude the use of the adopted NCPDP SCRIPT standard, and add an exemption for computer-generated faxes used by dispensers to request refills from providers that are not capable of receiving and processing refill requests using the adopted NCPDP SCRIPT standard.
CMS will accept comments on the proposed rule until August 29, 2008, and will respond to those comments in a final rule to be issued by November 1, 2008. The revised policies and payment rates will become effective January 1, 2009.
For more information, see www.cms.hhs.gov/center/physician.asp.
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