Anesthesiology Digest – March 26, 2021

March 26, 2021

Delay of Medicare Sequester Cuts Passed by Senate

By Jessie Hellmann | March 25, 2021

The Senate voted Thursday to delay Medicare payment cuts for the rest of the year, a big win for hospitals and providers.

The 2% cuts originally took effect in 2013 but were paused by Congress last year in response to the pandemic and its effect on providers’ finances.

The cuts totaling $18 billion were scheduled to resume next week absent Congressional action, but providers lobbied hard for an extension of the moratorium, arguing the pandemic continues to negatively impact their bottom lines.

The bill is expected to pass the House before being signed by President Joe Biden.

To read more, go to Modern Healthcare.

HHS Pauses Rule to Review and Eliminate Old Regulations

By Michael Brady | March 22, 2021

The Biden administration last week delayed a controversial Trump-era rule requiring HHS to assess nearly all its regulations after 10 years and end them automatically if the department doesn’t review them within five years.

HHS paused the rule, which was supposed to take effect on Monday, because of a lawsuit filed on Mar. 9 by several organizations. The American Lung Association, the National Association of Pediatric Nurses and others claimed the rule was a “ticking timebomb” that could severely disrupt the healthcare system by creating regulatory confusion—more than 17,000 rules could sunset by 2026, according to the lawsuit.

Federal regulators said the claims are “credible” and that they won’t move forward with the so-called “SUNSET” rule until the case makes its way through the courts.

“HHS is unaware of any benefits from the implementation of the SUNSET final rule that would be significantly curtailed from a stay of its effective date. The department is taking a fresh and critical look at the SUNSET final rule in light of the allegations in the complaint (although many of these concerns were also raised during the comment period on the proposed rule),” the rule said.

The rule subjects most regulations to a two-step review. HHS would first decide whether a rule has a significant economic impact on a large number of small entities. If it does, the department will review whether the rule is still needed; complaints about it; its complexity; if it duplicates or conflicts with other regulations; and whether the agency should rework or withdraw it because of technological, economic or legal changes.

But some healthcare groups have called the process duplicative and burdensome, noting that the Administrative Procedures Act already requires review and comments on proposed regulations. In particular, the Medicaid and CHIP Payment and Access Commission said the Trump-era plan would create confusion for managed care plans, states, providers and beneficiaries and force inexperienced staff to assess rules that may be essential to some HHS programs without understanding their impact.

To read more, go to Modern Healthcare.

The List of Excluded Individuals/Entities

March 2021

Your practice may be doing everything it possibly can to code/bill compliantly and stay off the OIG, CERT, RAC. MAC and anyone else’s list of “bad” actors. However, if you inadvertently hire a clinician who has been excluded from participating in a federal health care program, you may be subject to civil monetary penalties (CMP). And, if a current member of your practice has been excluded, you may also be liable. These liabilities and penalties can apply even if you were not aware of the exclusion. This Timely Topic will provide an overview of the List of Excluded Individuals/Entities (LEIE) listings to help inform you on:
• What actions can result in becoming classified as an excluded clinician?
• Where you can check to make sure all current and potential members of your practice are not on this list.
• A definition of the acronyms used in this article and websites where you can learn more about these programs and parties.

The US Department of Health and Human Services Office of Inspector General (HHS OIG) may exclude a healthcare professional or entity from participation in the Medicare, Medicaid or other federally funded health care program under authority granted to HHS in the Social Security Act. Exclusions may be mandatory or permissive.

Conviction for Medicare or Medicaid fraud, patient abuse/neglect, or unlawful prescribing or dispensing of controlled substances at the felony level are examples of actions that result in mandatory exclusion. Exclusion is required by law.

The OIG has some level of discretion in other circumstances. Examples here would include misdemeanor convictions for prescribing or dispensing controlled substances, revocation/surrender of license to provide care for professional competence or professional performance issues, and participation in kickback arrangements that are not lawful. Defaulting on a health education loan could trigger exclusion.
While a practice could be subject to CMP when it has an employee on the LEIE, the more immediate result is that it will not receive payment for services this employee provides to patients in a federally funded program (to include Medicare and Medicaid).

The OIG maintains the LEIE and updates it monthly. You can keep current on revisions by subscribing to updated from the OIG. A search function by which you can look for specific individuals or entities is also provided. It is recommended that you check the list on a routine basis.

To read more, go to ASA’s website.

House Democrats Reintroduce Medicare for All Legislation

March 19, 2021

On March 17, House Democrats introduced ‘Medicare for All’ legislation that would provide a blueprint for a government-run single-payer system that would eliminate most private health insurance.
The main sponsor of the bill is Rep. Pramila Jayapal (D-WA-7), and the bill is co-sponsored by over 100 House Democrats. As introduced, the bill, H.R. 1976, does not provide a plan for the financing of the new system. This legislation is similar to Medicare for All legislation introduced in past Congresses.

The proposal would create a two-year transformation of Medicare into a universal single-payer system, eliminating the age threshold for Medicare eligibility. The plan would expand Medicare coverage to include prescription drugs, dental and vision services, maternal care, and long-term care without charging co-pays, premiums or deductibles.

Last month, members of the American Society of Anesthesiologists (ASA) Executive Committee (EC) and ASA’s lobbying team met with key Committees and House and Senate leadership staff to discuss health care priorities, including Medicare for All. In particular, the EC met with staff of the House Congressional Progressive Caucus – the driving force behind “Medicare for All”—to express concern about the impact of the proposal on anesthesiologists. Specifically, the EC explained that Medicare rates are unsustainable for anesthesiologists’ practices.

Medicare payments for services of physician anesthesiologists have long been plagued by inequality and instability. The Medicare “33% problem” has been a persistent challenge by paying anesthesia services at only 33% of private pay rates, the lowest rate among all health professionals, while Medicare payments for other physician services are approximately 75% of commercial pay rates.

To read more, go to ASA’s website.

New COVID Relief Package Signed into Law

March 16, 2021

On Thursday March 11, President Joe Biden signed the American Rescue Plan Act (ARP or H.R 1319) into law. The $1.9 trillion bill is aimed towards continuing and accelerating efforts to combat the COVID-19 pandemic as well as to offer economic support to citizens, state and local governments, and small businesses. Although no direct funds for the Provider
Relief Fund (PRF) like previous COVID relief packages were included, there are some health provisions.

Disappointedly, the Medicare sequestration-related 2% physician payment cut scheduled for April 1 was not resolved in ARP. Further, because of ARP’s spending, an additional 4% Medicare sequester cut is triggered. The 4% cut would be implemented on January 1, 2022. ASA is currently working to block the implementation of both the 2% and 4% sequestration cuts.

The ARP provides $8.5 billion, through a look-a-like PRF, specifically for rural entities serving Medicare and Medicaid beneficiaries. This funding is for the Department of Health and Human Services (HHS) to allocate to eligible rural providers for health care-related expenses and lost revenues attributable to COVID-19 not reimbursed (or obligated to be reimbursed) by other sources. Notably, the ARP funds are only available to rural providers or suppliers and unlike the PRF’s targeted rural distributions, which were distributed directly to select providers by HHS, rural providers and suppliers seeking the ARP funds must submit an application to HHS.

The legislation also provides HHS with $91 billion for accelerating R&D, manufacturing and distributing vaccines, and increasing the healthcare workforce. A portion of the funds allocated to the HHS ($330 million) are specific for funding teaching health centers that operate graduate medical residency training programs. The funds are meant to maintain and expand existing programs, with particular emphasis on primary care where funding is set to increase by $10,000 per resident in hopes of boosting federal response to public health emergencies.

The HHS also received funds to provide resources for prevention and treatment of mental health and substance abuse disorders, especially in rural areas. The Health Resources and Services Administration (HRSA) was also included in the task of using evidence-based strategies in addressing the increasing rate of suicide, burnout, mental health conditions, and substance abuse disorders among health care professionals.

ARP also addressed several other ongoing issues facing the American people during the pandemic, including food security, nutrition assistance, education and childcare, housing and homelessness, and increased support for the aviation and restaurant sectors.

The bill also included legislation and funding for Medicare and Medicaid spending, most notably providing higher federal matching funds to states in attempts to promote home and community-based services. States that newly expanded Medicaid would receive an additional 5% increase in their regular federal Medicaid matching rate (FMAP) for two years. This increase is in addition to the 6.2% FMAP that was made available through the duration of the COVID-19 public health emergency. The bill also requires Medicaid and CHIP to cover COVID-19 vaccines and treatments, including expanding the state Medicaid option for coverage of COVID-19 testing for the uninsured.

To read more, go to ASA’s website.

AMA Issues Clarification on New Reporting of Office/Outpatient E/M Services

March 15, 2021

Physician anesthesiologists and pain medicine physicians who may be reporting office/outpatient evaluation and management (E/M) services should be aware of new information from the AMA on the proper reporting of CPT® codes 99202 – 99215. The AMA has issued this updated guidance based on feedback it has received form those who report these service and the update is intended to clarify intent and address confusion.

Please review the updated information from the AMA here.

Surprise Billing Ban Details Yet to Be Determined, Leaving Industry Fights to Come

By Michael Brady | March 10, 2021

Providers and insurers will continue their fight over surprise billing as federal officials figure out how to put the No Surprises Act into practice, according to experts.
The new law protects consumers from receiving unexpected medical bills resulting from out-of-network emergency care delivered by an out-of-network facility or out-of-network providers at an in-network facility. It also blocks out-of-network providers at in-network facilities from balance billing patients for non-emergency care unless they get patient consent. But patients will still be responsible for paying the in-network cost-sharing amount.

The heart of the law is a new independent dispute resolution process, which gives providers and insurers 30 days to agree to a price for the medical services delivered. If they don’t settle, they’re supposed to enter arbitration, during which each side will present a final offer and make their case for why their offer is best. The arbitrator must then pick one of the two offers. They can’t split the difference.
Congress’ decision to go with baseball-style arbitration to settle payment disputes between providers and insurers was a victory for providers since insurers’ preferred benchmarking approach would have led to lower payments for doctors and hospitals.

But the battle isn’t over yet, as federal regulators still have a lot of details to work out before the law takes effect next year.

Policymakers must recruit entities to carry out the arbitration process and provide them with guidance about how to consider a range of factors during arbitration.

To read more, go to Modern Healthcare.