2021 Mid-Year Advocacy Update

June 8, 2021

As we reach the mid-point of the year, we are pleased to share that we experienced a significant increase in our advocate base with over 900 new advocates since the beginning of the year. In this constantly evolving market, we are very proud that so many individuals are supporting our advocacy efforts. The more voices we have speaking up to our legislative leaders, the more opportunity we have to continue to make an impact for you and your patients. Thank you for your support!

PECOS 2.0/Multi-Factor Authentication

Last year our provider enrollment and advocacy teams worked directly with CMS to outline the concerns of the way that the Provider Enrollment, Chain, and Ownership System (PECOS) and Multi-Factor Authentication (MFA) process was laid out.  As a direct result of the discussions Zotec had with CMS, they decided to delay the PECOS/MFA rollout for over a year. The new MFA rollout is currently scheduled to take place in September 2021.

CMS is in the process of re-engineering PECOS. As a result of our communications on the MFA rollout CMS has also offered us an opportunity to collaborate with upcoming design, workflow, and usability of PECOS 2.0. In preparation for the PECOS 2.0 rollout CMS created a number of Provider Expert Panel (PEP) groups.  These groups will help provide feedback so CMS can better understand what is important for the provider community and other stakeholders.  CMS will take this information into consideration as they work to make PECOS into a modern solution that reduces provider burden and provides transparency in the enrollment process. 

Zotec Partners is pleased to continue to work directly with CMS as subject matter experts on this important initiative.  We are dedicated to taking the necessary steps to set up compliant access for the MFA rollout and on PECOS 2.0, for our clients, in the months ahead.

Legislative Updates

We recently enhanced our legislative tracking, which ensures that our team is getting the latest, and most up-to-date, information coming from Washington D.C. and all 50 states.  Here is an update of all of the legislation we have taken action on and are currently monitoring.

2022 Physician Fee Schedule/Medicare Sequester:

On April 13, Congress voted to extended the 2% Medicare sequester through the end of 2021. This legislation extends the current 2% Medicare sequester moratorium established by the Coronavirus Aid, Relief, and Economic Security (CARES) Act through the end of 2021. Without congressional action, the moratorium was set to expire after March 31, 2021.

The outstanding issue of an additional 4% Medicare sequestration cut, stemming from the budgetary effects of the American Rescue Plan, still remains. The American Rescue Plan ($1.9T) was not completely “paid for” so Congress enacted “pay as you go” requirements, which triggered the sequester cuts. The House passed a resolution to address these cuts, but Senate has not yet acted. We sent out a call to action and 368 advocates contacted their members of Congress.

Based on past history, Congress may wait until Q4 2021 before turning their attention to these cuts, however, there is still a -9.75% Medicare cut looming that takes effect on Jan. 1, 2022. Zotec Partners will continue to diligently advocate to prevent these cuts from taking effect in 2022 and reach out for your assistance as Congress takes up this issue later in the year.

Fair Debt Collection Act:

Recently the House passed H.R.2547215 –207, passing on party lines, which was expected.

Introduced in April, the Comprehensive Debt Collection Improvement Act, H.R. 2547, would provide new consumer protections against certain debt collection practices, and specifically includes a section on medical debt collection. We sent out a call to action out and 343 advocates took action and contacted their legislator.

It is unclear at this time if the Senate will hear it or not.  The bill has become part of a collection of many other pieces of legislation that we will continue to keep watching and will keep you updated on any changes in the progression of this legislation.

Clinical Decision Support:

The Protecting Access to Medicare Act (PAMA) of 2014, established a program to increase the rate of “Appropriate Advanced Diagnostic Imaging Services” provided to Medicare beneficiaries.

Radiology practitioners ordering an advanced diagnostic imaging service for a Medicare beneficiary,  or clinical staff acting under his/her direction, will be required to consult a qualified Clinical Decision Support Mechanism (CDSM).  

Currently, the program is set to be implemented on January 1, 2022.  However, CMS has indicated they have encountered challenges in implementing the law – particularly the  claims-based reporting requirements where radiologists/imaging facilities are required to include the applicable G-Code and modifier on the claim.

The ACR is urging CMS to express support to Congress for eliminating the real-time claims processing element; along with a coalition of about 10 – 12 medical societies representing the “ordering physicians” that want to eliminate the program in general.

Out of Network Billing (OON)/Surprise Medical Billing (SMB):

Xavier Becerra, newly appointed secretary of HHS, has pledged to implement a balanced approach to the No Surprises Act.  HHS is meeting with stakeholders to request to start this process, which should include the following:

  • All independent dispute resolution (IDR) factors should be weighed equally and the IDR process will be critical to holding plans accountable, while working to keep the patient out of the mix.
  • To make sure that the process is fair and balanced and that providers and insurers are treated equally.
  • To avoid any rules that would lead to a de facto benchmark payment rate, ensuring the neutrality of the data used to develop the qualified payment amount; and
  • That plans be held accountable for responding to claims submission in a timely fashion.

The No Surprises Act impacts state OON/SMB laws.  Recently, we sent a call to action out in the state of North Carolina to defer state level OON billing, which was referred to the Commerce and Insurance committee for review.

In addition to the federal advocacy, Zotec is working with physician and hospital stakeholders in GA, OH, MI, and VA – each state which has recently enacted an SMB law—as the regulators in these states create rulemaking to implement the new state laws. We will continue to  monitor the legislation carefully in all 50 states.