Recently the Food and Drug Administration has been planning to make changes to its medical device clearance process. These changes they are planning on implementing would mean they would rely far less on older predicate devices so that they could offer a modernized pathway for high-tech medical innovations.
Emerald Coast Medical Association aims to keep our members up to date on the newest legal changes. CMS listened to doctors and decided to delay any changes to codes for Medicare patient visits until 2021. According to the Centers for Medicare & Medicaid Services, doctors were worried that the plan would cut revenue for physicians who care for Medicare patients. Although CMS made changed to its plan, it did decide to continue with its plan to consolidate codes for Medicare patient visits.
Seema Verma, a CMS Administrator, said that they would consolidate codes for “evaluation and management” (E/M) visits to three, maintaining the level 5 code that is used for physicians who see the sickest patients who require more services. The agency will work with doctors to iron out the details, which will delay implementation to 2021. The E/M changes are part of a final rule that outlines the physician fee schedule for 2019. Along with that also come changes to the third year of the physician payment system implemented under MACRA.
The American Medical Association is on board with the revisions of the original proposed E/M policies. They are grateful that the administration is not moving forward with the payment collapse of E/M codes in 2019. The two-year window allows time for an AMA-convened workgroup to look over and make recommendations on this controversial topic.
Effective January 1, 2019, CMS will finalize several burden-reduction proposals that were supported by doctors. The final rule, though, will include revisions that preserve access to care for complex patients, equalize certain payments for primary and specialty care, and allow the delay in implementation of E/M coding reforms until 2021.
The original implementation would have been much sooner, but CMS received over 15,000 comments on a proposed rule that was released in July. Most of the 15,000 comments were in opposition to the change. This change would have collapsed payment rates for eight office visit services for new and established patients down to two each, a massive cut in the overall scheme of things. In addition to that, it also was said it could underpay doctors who treat the sickest patients, which more than 150 medical groups opposed and sent letters disputing the plan to consolidate E/M codes. CMS has released fact sheets with more details about the physician fee schedule, and one outlining changes to the quality payment program under MACRA.
The Department of Health and Human Services and the Drug Enforcement Administration have recently been working together to increase access to medication-assisted addiction treatment (MAT). The HHS and DEA are aware that doctors able to prescribe these medications are in short supply, which is one of the reasons they are looking to ease restrictions on MAT.
Emerald Coast Medical Association is dedicated to keeping our members up to date on any legal changes going on in the medical community. The most recent one being a massive package of measures in response to the ongoing opioid crisis. This package includes over 70 bills, each of which makes a significant impact on how the opioid crisis is handled.
The medical community has its own laws that can be changed. Often, these laws have a significant impact on the medical community and the way patients or physicians are handled. At Emerald Coast Medical Association, we strive to keep our members up to date on even the smallest of legal changes.
Topics: Medical Law
Tuesday, September 4th marked a big moment for providers in the Affordable Care Act, when Montana Health Co-op was awarded a win in the ongoing battle between insurers and the government over cost-sharing reduction payments (CSRs). The health cooperative, which serves about 50,000 members throughout Idaho and Montana, filed suit against the federal government in January, claiming it was owed approximately $5 million in CSRs for 2017.
In March of 2018, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would exempt states with at least 85 percent of their Medicaid managed care population from most access-monitoring requirements for services provided through the traditional fee-for-service avenue. This would immediately exempt at least 17 states from existing access monitoring requirements, and could also exempt another dozen states whose managed-care enrollment is close to the threshold.
"The pen is mightier than the sword" is an age-old adage, coined by English author Edward Bulwer-Lytton. Health and Human Services Secretary Alex Azar would agree, and would go on to add that the pen is also mightier than Congress.