|Association Exec: Proposed PFS Stands to Do ‘Incalculable Damage to the Medical Profession’ |
By Dave Pearson | July 13, 2022
Last week the Centers for Medicare and Medicaid Services posted a tentative Physician Fee Schedule for 2023. Initial reactions from radiology were muted. That changed this Wednesday.
“CMS couldn’t have picked a worse time to cut Medicare payments to physicians,” says Bob Still, executive director of the Radiology Business Management Association, in prepared remarks sent to the press July 13. “We’re still in the midst of the pandemic, and patients who avoided regular health screenings are returning to doctors’ offices. And it’s that exact moment—when patients need us most—that Congress and the White House decide to introduce disastrous cuts.”
This 2023 PFS “will do incalculable damage to the medical profession,” Still adds. “[W]orst of all, it will hurt the most vulnerable populations.” The materials were sent by RBMA’s advocacy arm, the Radiology Patient Action Network.
RPAN says that, when combined with expiring Congressional support, the 2023 PFS will result in double-digit pay cuts to radiologists and other medical specialists. In the process, RPAN warns, the actions will “devastate patient populations throughout the United States.”
To read more, go to Radiology Business.
|Cigna Delays New Paperwork Demand Criticized by Physician Group |
By Andrew Cass | July 13, 2022
Cigna is delaying and reevaluating a new paperwork demand that was set to go into effect Aug. 13 after receiving pushback from the California Medical Association and American Medical Association.
The now-delayed policy change would require the submission of medical records for all evaluation and management claims with CPT 99212-99215 and modifier 25 when a minor procedure is billed.
In June, the California Medical Association sent a letter to the payer arguing the policy would result in significant, unnecessary administrative burden and compliance cost to physician practices. It would also discourage physicians from providing unscheduled services and create duplicate requests, wasting healthcare dollars, the association said.
The California Medical Association said in a July 12 news release that Cigna is putting the policy under further after the group and American Medical Association contacted the payer about their concerns.
“CMA believes a more collaborative approach to identify alternative methodologies for cost containment — including provider education on proper coding practices that do not bluntly penalize physicians using the modifier appropriately — will prove more effective and less costly in the long term,” the group said in the news release.
To read more, go to Becker’s Payer Issues.
|Supreme Court’s EPA Ruling Jeopardizes Healthcare Regulations |
By Maya Goldman | July 12, 2022
Healthcare regulations could be thrown into question following a Supreme Court decision last month that curtails a different agency’s authority to interpret laws.
While the ruling may not have much of an immediate impact on healthcare, it creates a landscape of uncertainty that could hamper healthcare companies that need regulatory clarity to plan ahead.
The Supreme Court ruled that a method the Environmental Protection Agency created to cap emissions went beyond the scope of the agency’s congressionally delegated authority. The 6-3 opinion written by Chief Justice John Roberts indicates the current court majority believes big policy questions need to be left to the legislative branch. “Agencies have only those powers given to them by Congress…. We presume that ‘Congress intends to make major policy decisions itself, not leave those decisions to agencies,'” Roberts wrote in his opinion for West Virginia v. EPA, quoting a court document from a separate 2017 case.
Although the decision doesn’t explicitly affect healthcare policy, it could have ramifications for the Health and Human Services Department and the entities it regulates, said Michael Tuteur, a partner at law firm Foley & Lardner.
The Supreme Court’s opinion rests on the “major questions” doctrine. Essentially, courts can look at any regulation brought in front of it and decide whether the substance of the rule qualifies as a “major question” over which Congress—not an agency—should have authority.
The Supreme Court has relied on this framework for over two decades, but last month’s ruling indicates the current court is skeptical of the administrative state, Tuteur said. The Supreme Court ruled the EPA policy counted as “major” because of its economic impact. But the high court didn’t rely on this doctrine in decisions this term on whether HHS correctly interpreted the law for disproportionate share hospital payments or the 340B drug discount program, each of which is worth billions of dollars, said Robert Wanerman, an attorney at law firm Epstein Becker Green.
This lack of clarity could spell trouble for healthcare organizations, which are highly regulated by HHS and the Centers for Medicare and Medicaid Services, Tuteur said. CMS alone submitted about 50 regulations to the White House Office of Management and Budget last year.
To read more, go to Modern Healthcare.
ACR’s Reading of 5 Planks in Proposed 2023 MPFS
Dave Person | July 8, 2023
CMS has released its highly anticipated tentative rule for governing the 2023 Medicare Physician Fee Schedule (MPFS). In turn, the American College of Radiology has posted a first-look summary focused on the schedule’s implications for medical imaging.
The proposed rule is open for public comment, and the final edition is expected to drop in the fall.
Here are five highlights from the ACR summary as posted by the college shortly after CMS went live with its proposal July 7.
1. Conversion Factor and CMS Overall Impact Estimates
2. Valuation of Imaging Services
3. Clinical Labor Update
4. Practice Expense Data Collection/Methodology
5. Colorectal Cancer Screening Coverage
CMS’s draft MPFS for 2023 also proposes particulars and provisions of the Medicare Shared Savings Program (MSSP) and Quality Payment Program (QPP). The ACR summary drills down into these as well, adding that it will continue to review the proposed rule and issue a more detailed summary soon.
Click here for ACR’s preliminary summary of the proposed rule, here for a CMS fact sheet and here for CMS’s press release.
Also, along with issuing the proposed rule, CMS is referring stakeholders interested in related Appropriate Use Criteria and Clinical Decision Support requirements to its webpages covering those topics at CMS.gov.
To read more, go to Radiology Business.
Proposed Medicare Physician Fee Schedule Includes Payment Cuts
By Amy Baxter | July 8, 2022
The Centers for Medicare and Medicaid Services (CMS) released the 2023 Physician Fee Schedule (PFS) proposed rule, and medical associations are not happy with the proposed changes.
Namely, the 2023 plan would actually cut payments by 4.4%, as the proposed calendar year 2023 PFS conversion factor is $33.08, a decrease of $1.53 to the 2022 PFS conversion factor of $34.61.
Physician services that are paid under the PFS are across a variety of settings, including physician offices, hospitals, ambulatory surgical centers (ASCs), skilled nursing facilities and other post-acute care settings, hospices, outpatient dialysis facilities, clinical laboratories and beneficiaries’ homes. Suppliers for technical services are also paid under the PFS when institutional payments are not made. Medicare typically makes payments under a single rate for services, while PFS rates paid to physicians and other billing practitioners in facility settings reflect only the portion of the resources typically incurred by the practitioner in the course of furnishing the service. Diagnostic tests and some other services may have a separate payment under PFS, and the system bases payments on the relative resources typically used to furnish the service
The proposed rule solicits public comments on the policy changes, and stakeholders can leave public comments prior to the finalization of the PFS.
The proposed 2023 PFS was met with immediate criticism from the American Medical Association, which said it is still reviewing the proposed rule and will have more specific comments later. The proposed rule comes as healthcare providers have been stretched thin over the last two years dealing with the COVID-19 pandemic. From rising costs, personal protective equipment (PPE) shortages and a labor squeeze, healthcare institutions are still facing numerous challenges. A payment rate cut could further squeeze resources.
“It is immediately apparent that the rule not only fails to account for inflation in practice costs and COVID-related challenges to practice sustainability, but also includes a significant and damaging across-the-board reduction in payment rates,” AMA President Jack Resneck, MD, said in a statement. “Such a move would create long-term financial instability in the Medicare physician payment system and threaten patient access to Medicare-participating physicians. We will be working with Congress to prevent this harmful outcome.”
To read more, go to Health Exec.