July 16, 2015
National UpdateCMS to make ICD-10 transition less disruptive
The Oct. 1 hard deadline to implement the ICD-10 code set is just around the corner, but many physicians are concerned about potential claims disruptions that could result when implementing the code set into their practices. In response, the AMA worked with the Centers for Medicare & Medicaid Services (CMS) to ease the transition.
The AMA and CMS released a joint statement July 6 announcing a 12-month transition period during which time Medicare claims will not be denied solely based on the specificity of the diagnosis codes, as long as they are from the appropriate ICD-10 code family.
The changes address:
- Claim denials. For the first year ICD-10 is in place, Medicare claims will not be denied solely based on the specificity of the diagnosis codes as long as they are from the appropriate family of ICD-10 codes.
This means that Medicare will not deny payment for these unintentional errors as practices become accustomed to ICD-10 coding. In addition, Medicare claims will not be audited based on the specificity of the diagnosis codes as long as they are from the appropriate family of codes. This transition period will give physicians and their practice teams time to get up to speed on the more complicated code set.
Both Medicare Administrative Contractors and Recovery Audit Contractors will be required to follow this policy.
- Quality-reporting penalties. Similar to claim denials, CMS will not subject physicians to penalties for the Physician Quality Reporting System, the value-based payment modifier or meaningful use based on the specificity of diagnosis codes as long as they use a code from the correct ICD-10 family of codes.
In addition, penalties will not be applied if CMS experiences difficulties calculating quality scores for these programs as a result of ICD-10 implementation.
- Payment disruptions. If Medicare contractors are unable to process claims as a result of problems with ICD-10, CMS will authorize advance payments to physicians.
- Navigating transition problems. CMS said it will establish a communication center to monitor issues and resolve them as quickly as possible. This will include an “ICD-10 ombudsman” devoted to triaging physician issues.
The AMA will continue to work with CMS as the deadline approaches and following the implementation to address issues as they arise. Get eight must-have ICD-10 resources at AMA Wire®.21st Century Cures bill moves forward
The U.S. House of Representatives last week overwhelmingly passed H.R. 6, the 21st Century Cures Act, which would accelerate the discovery, development and delivery of drugs and medical devices.
The legislation, spearheaded by House Energy and Commerce chairman Rep. Fred Upton, R-Mich., and committee member Rep. Diana DeGette, D-Colo., also includes $9.3 billion in additional funding for the National Institutes of Health (NIH) and the U.S. Food & Drug Administration (FDA).
Earlier this year, U.S. Senate Health, Education, Labor and Pensions (HELP) Committee chairman Sen. Lamar Alexander, R-Tenn., and Sen. Richard Burr, R-N.C., released “Innovation for Healthier Americans” to begin a concurrent Senate effort to modernize the FDA and NIH. The HELP Committee held bipartisan working group meetings to discuss policy issues similar to those addressed in H.R. 6 and is expected to release its own narrower bill later this year.
The AMA has been engaged with both chambers on several issues that are being considered as part of these efforts and will continue to work with Congress throughout the process.
The Centers for Medicare & Medicaid Services (CMS) recently released the 2016 Medicare physician payment schedule proposed rule as well as a proposal for a new bundled payment program for hip and knee procedures.
In the rule, the agency proposes to adopt Current Procedural Technology (CPT®) codes and recommended values from the AMA/Specialty Society Relative Value Update Committee (RUC) to pay for advance care planning services. It also seeks comments on potential coverage of collaborative care services and expansion of the Comprehensive Primary Care initiative. The proposed rule also includes policy changes on misvalued codes, physician self-referral, appropriate use criteria for advanced diagnostic imaging and the value-based payment modifier.
The hip and knee bundled payment proposal would initiate a five-year mandatory test in which fee-for-service claims for inpatient, post-acute care and physician services for joint replacement procedures would continue to be submitted, but the hospitals would be responsible for reducing the total cost of these episodes up until 90 days after discharge, including physician and post-acute services. The program would be mandatory for hospitals in 75 regions throughout the country. After a reconciliation process, the hospitals could share in savings for the episodes or, if spending is above the amount set by Medicare, would have to repay the program for a portion of the overage.
The AMA is in the process of reviewing and analyzing both proposals and will submit public comments on them. Watch AMA Wire for more details.
The Centers for Medicare & Medicaid Services in June instructed Medicare contractors to increase the Medicare physician payment schedule conversion factor by 0.5 percent, effective July 1.
The mid-year payment increase was required by the legislation that repealed the sustainable growth rate, the Medicare Access and CHIP Reauthorization Act (MACRA). Another 0.5 percent payment update will be implemented on Jan. 1.
Learn more about the provisions of MACRA at AMA Wire.
A recent report on physicians’ first year under Medicare’s value-based modifier (VBM) indicates that whether or not a group received a bonus or penalty depended more on quality measures than cost measures. It also suggests that groups treating many high-risk and chronically ill patients are more likely to fare poorly under the VBM than those with lower concentrations of these patients.
The report from the Centers for Medicare & Medicaid Services focuses on the 1,010 large group practices with 100 or more practitioners that were subject to the VBM in 2015 based on their 2013 performance.
Fourteen of the groups received payment increases of nearly 5 percent per service, which are projected to lead to aggregate increases that range from $424,383 to $10,953,475. Some 330 groups saw reductions of 0.5 percent to 1 percent per service and will see total losses ranging from $21,321 to $10,953,768.
Issue SpotlightFed up with EHRs? Share concerns during AMA town hall
Physicians aren’t happy with the way electronic health record (EHR) systems are working, largely due to government regulations that have encroached on time with patients and turned physicians into typists. If you’re frustrated with your EHR and looming meaningful use regulations, join a special town hall meeting that will be live-streamed online from 7 to 8:30 p.m. Eastern time Monday.
Among the national and local leaders who will be a part of the conversation will be Rep. Tom Price, MD, a Republican from Georgia’s 6th District, and AMA President Steven J. Stack, MD. This event is hosted by the AMA and the Medical Association of Georgia in Atlanta, and local physicians can attend in person—sign up online. Those who live-stream the town hall can participate on Twitter with #FixEHR.
Government requirements have twisted EHR technology so it interferes with face-to-face discussions with patients, requires physicians to spend too much time performing clerical work and creates new costs that divert resources away from patient care improvements. Meanwhile, the much anticipated benefits of being able to share important patient health care information electronically among providers in different settings have gone unfulfilled.
Physician participation in Stage 2 of meaningful use is less than 10 percent, even though 80 percent of physicians have adopted EHRs. Moving forward with Stage 3 could mean less time with patients, hindrances to practice innovation and costly penalties. The town hall will include information about the AMA’s push to reframe federal regulations and encourage better EHR design to emphasize high-quality patient care.
Learn more about why the Centers for Medicare & Medicaid Services should postpone Stage 3, and read more meaningful use news at AMA Wire.
State UpdateRhode Island physicians push for Good Samaritan protections
Three prominent Rhode Island physicians are urging the state attorney general and police chiefs across the state to publicly commit to abide by Rhode Island’s recently expired Good Samaritan law until the state general assembly reconvenes.
Legislation introduced by the Rhode Island Medical Society (RIMS) and supported by the AMA (log in) would have expanded and extended existing Good Samaritan protections to those who seek help for someone experiencing an overdose because such provisions will help save lives. The current law sunset on July 1.
“The Good Samaritan law is designed to counteract [that] the fear of many people dealing with an overdose is calling for medical assistance and thereby becoming an unwilling participant in the criminal justice system by that act,” said the Rhode Island physicians, including RIMS President Peter Karczmar, MD, in their letter. “We have a public health crisis that cannot be resolved by the criminal justice system.”
David C. Lewis, MD, founder of the Brown University Center for Alcohol and Addiction Studies, and John P. Femino, MD, the immediate past president of the Rhode Island Society for Addiction Medicine, also signed the letter.
State legislators should support network adequacy standards when their legislatures have meaningful regulatory oversight of health plans, the AMA told attendees at the National Conference of Insurance Legislators (NCOIL) annual meeting.
David Tayloe, Jr., MD, a member of the AMA Council on Legislation, spoke on behalf of the AMA and advocated for:
- Networks that include a full range of specialty and subspecialty providers
- Development and use of quantitative standards to determine adequacy
- Regulation of tiered networks to ensure patients have access to all covered services in the lowest cost-sharing level
- Transparency in provider selection standards
- Accurate provider directories
Dr. Tayloe’s testimony was part of a June 17 panel at the NCOIL meeting addressing network adequacy. Other panelists included the chair of the National Association of Insurance Commissioner’s subgroup on network adequacy, America’s Health Insurance Plans and the American Heart Association. For more information, please contact Emily Carroll of the AMA.Back to Top
Other NewsPhysician-owned practices still dominate medical marketplace
A new AMA report (log in) looked at both short- and long-term changes in physician practice arrangements using data from the most recent AMA Physician Practice Benchmark Survey, finding that growth in hospital ownership has been slow while most physicians still provide care for patients in small practices.
The number of physicians in small practices with 10 or fewer physicians remained the majority at 60.7 percent. And 56.8 percent of physicians worked in practices wholly owned by physicians, only a slight decrease from 2012, when 60.1 percent of physicians worked in physician-owned practices.
The share of physicians who worked directly for a hospital or in practices that had at least some hospital ownership, meanwhile, increased modestly from 29 percent in 2012 to 32.8 percent in 2014.
Notable long-term changes have occurred in terms of practice size, and whether physicians are owners or employees of their practices. The share of physicians in small practices fell from 79.6 percent in 1983, to the current 60.7 percent. The percentage of physicians who are owners of their practices fell from 76.1 percent to 50.8 percent in that same timeframe.
Access the report on the AMA policy research Web page under the “medical practice” section, or read more at AMA Wire.
Physicians can now access the most current codes and code combinations used in standard electronic remittance advice (ERA) transactions in the updated Claims Workflow Assistant.
This free online tool allows physicians and practice staff to look up the adjustment and remark codes used in ERA to explain differences between billed and paid amounts. The Claims Workflow Assistant also provides suggested workflows to help practices build a successful claims denial management process.
Access an archived AMA webinar “ERAse payment issues with ERA” to see a demonstration of the Claims Workflow Assistant and to learn more about how ERA can improve practice efficiency. The AMA’s ERA toolkit provides detailed information on how to successfully and optimally implement ERA in physician practices.
As the nation suffers from a prescription opioid and heroin overdose epidemic, the nation is taking notice and more importantly—taking action.
Here’s what has been going on:
- The U.S. Food and Drug Administration (FDA) earlier this month held a public hearing to explore the uptake and use of naloxone, a lifesaving medication that can reverse opioid overdoses.
- Patrice A. Harris, MD, member of the AMA Board of Trustees, recently testified before Congress in support of new state laws to put naloxone into the hands of appropriately trained first responders and friends and family members who may be in a position to help save lives.
- The AMA supported nearly 20 new state laws in the past two years to increase use of naloxone and emphasized the importance of these laws to many key stakeholders, including the National Governors Association (log in to read a recent letter).
Voice your concerns about electronic health records and meaningful use at a special town hall in Atlanta. Rep. Tom Price, MD, a Republican from Georgia’s 6th District, and AMA President Steven J. Stack, MD, will host the meeting from 7 to 9 p.m. Eastern time July 20 in Atlanta. Register to participate in-person or live-stream the event online.
Sign up for the 2016 AMPAC Candidate Workshop, which prepares those considering a run for public office. For more information or to apply, please see the online registration form or email Jim Wilson of the AMA.
Register for the 2016 AMPAC Campaign School, which is for AMA members who wish to become involved in the political process as advocates and volunteers for medicine-friendly candidates. For more information or to apply, please see the online registration form or email Jim Wilson of the AMA.