Congress Eyes E/M Cuts to Pay for “Doc Fix”
On Tuesday, a Democrat congressional aide on the Senate Finance Committee suggested that cuts to non-emergency evaluation and management (“E/M”) services may be considered as a way to offset the cost of “doc fix” legislation Congress must pass before the end of the year. The proposal, which would cap payment for non-emergency E/M services in the outpatient department at the same rate as a physician’s office, was recommended by the Medicare Payment Advisory Commission earlier this year. It was also included in prior legislation introduced in the House as an offset to avoid the 27% cut in Medicare reimbursement physicians face under the current Sustainable Growth Rate (“SGR”) formula. Although House Republicans stripped the E/M measure from the last “doc fix” bill before it was passed, it would save an estimated $6.8 billion over 10 years, which makes it difficult for lawmakers to take off the table when deciding how to pay for the bill this year. Legislation to avoid Medicare physician pay cuts under the SGR formula is expected to be the only health care-related legislation Congress considers when it returns for the post-election lame duck session on November 13.
GOP Senators Have Questions about Meaningful Use
On October 17, four GOP Senate Finance committee members wrote a letter to HHS Secretary Sebelius questioning the Electronic Health Records (“EHRs”) Meaningful Use Incentive program. In the letter, Sens. Burr (NC), Coburn (OK), Roberts (KA) and Thune (SD) note that despite $6.6 billion in EHR incentives already distributed to providers, concerns exist regarding the increase in Medicare billing and boosting of diagnostic tests.
The letter asks the following questions:
- Does the use of taxpayer-subsidized EHRs, in some circumstances, increase the utilization of diagnostic tests rather than reduce them?
- Has the digitalization of records and broader adoption of EHRs increased providers’ billing of Medicare and increased the overall costs of the program for taxpayers?
- Have some health care providers received federal subsidies for EHR systems they had in place prior to the adoption of federal standards?
The Senate letter comes on the heels of the House Ways and Means letter, which asked HHS Secretary Sebelius to suspend payments related to the EHR incentive program.
Legislation Introduced to Reform Medicare Audit Programs
On October 16, Rep. Graves (R-MO) and Rep. Schiff (D-CA) introduced legislation (H.R. 6575) that would reform the Medicare audit programs such as recovery audit contractors. The bill would implement financial penalties for recovery auditors that have a pattern of failing to comply with program requirements. The bill establishes a consolidated limit for medical record requests. Additionally, the bill would allow denied inpatient claims to be billed as outpatient claims and restores due process under the AB Rebilling demonstration.
While Rep. Graves’ staff acknowledges the bill is unlikely to pass this Congress, the introduction sets the stage for committee hearings and possible movement next Congress. The AHA supports this bill, saying it provides “needed guidance for medical necessity audits, keeping auditors out of making medical decisions…”
No Sign of Key Health Regulations at OMB
The release of pending health regulations stemming from the Affordable Care Act have been held up in the weeks and months leading up to the election. Many are speculating the Administration is delaying the release of major regulations prior to the November 6 election.
Regulations still not seen on the White House OMB website include rules governing state insurance markets, rules on the federally facilitated exchange, regulations on essential health benefits, a notice concerning benefit and payment provisions.
Once a rule moves to the White House Office of Management and Budget (“OMB”), review of regulations generally takes weeks to months before being formally published. It is uncertain how quickly the delayed regulations will be issued after post-election.
GOP Letter Calls for Release of CMS Report on Fraud Prevention
On October 15, two Finance Committee senators wrote CMS seeking the immediate release of a statutorily mandated report on the fraud prevention system (“FPS”). CMS’s report on the FPS was due October 1, 2012.
In the letter, the Sens. Hatch (R-UT) and Coburn (R-OK) expressed their concerns over the automated provider screening system, which they believe has not been effective in weeding out fraud among Medicare providers. The FPS was launched in July 2011 and uses predictive modeling to review all Medicare fee-for service claims for indications of fraud. The senators said the delay in receiving the CMS report raises questions about the reliability of CMS data.
This is the second letter from the GOP Senate Finance Committee to CMS regarding the reliability of the FPS.
For more information, please contact John F. Williams, III at 317.977.1462 or jwilliams@wp.hallrender.com.
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