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Medicare Panel Mulls Recommending Doctor, Hospice Payment Freeze

Dec. 9, 2021, 11:37 PM

Physicians and health professionals, ambulatory surgical centers, and hospice providers would see no increase in Medicare payments in 2023 under draft recommendations adopted Thursday by a congressional advisory panel.

Only acute care hospitals and dialysis facilities would see payment bumps under the preliminary recommendations of the Medicare Payment Advisory Commission.

MedPAC provides lawmakers with analysis and policy advice on the taxpayer-funded Medicare program. Its recommendations are nonbinding, but Congress relies heavily on commissioners’ expertise when making funding decisions.

Each year, the commission advises Congress about how to update payment rates for health providers that treat Medicare beneficiaries. Final commission recommendations will be voted on in January 2022. All final recommendations for 2023 will be included in the commission’s March 2022 report to Congress on Medicare payment policy.

The panel’s draft recommendation would increase the 2022 Medicare base payment rate for acute care hospitals by 2% in 2023. Dialysis facilities would see a 1.2% payment hike under another commission draft recommendation.

The panel moved to recommend no Medicare payment update for physicians and other clinicians in 2023, citing adequate reimbursement rates. But both groups of providers could receive positive or negative payment adjustments for providing quality care under the Merit-based Incentive Payment System, or MIPS, which measures an eligible clinician’s performance against their peers.

They could also receive a 5% payment bonus for participation in an advanced alternative payment model, in which they’re eligible for bonuses for providing high quality care and risk payment reductions when they don’t.

‘Claims Modifier’ for Telehealth

A second draft recommendation for physicians and other health professionals would require them to use a “claims modifier” to identify when they’ve provided audio-only telehealth services. The Centers for Medicare & Medicaid Services already requires the modifier for audio-only telehealth services that deal with substance abuse disorder and mental health issues. The draft recommendation would extend this requirement to all audio-only telehealth services.

In addition to a draft recommendation to eliminate a scheduled rate increase for ambulatory surgical centers in 2023, the commission is also mulling a recommendation for the facilities to provide annual cost reports to the CMS.

The commission has called on the Department of Health and Human Services to require such reports from surgical centers since 2009. Without the documentation of revenue and profit margins, the commission says it’s difficult to recommend payment rate adjustments for surgical centers. A commission analyst said the cost reports could be limited in scope to limit administrative burden.

In addition to a draft recommendation of no payment increase for hospice providers, the commission also moved to recommend a 20% cut in Medicare’s annual per-patient payment limit, or “aggregate cap,” for hospice providers.

The hospice aggregate cap is currently just over $31,000. If a hospice provider’s annual Medicare payments divided by the number of beneficiaries exceeds the cap amount, the facility must repay the excess payments.

The commission also issued a draft recommendation that a wage adjustment, to reflect area pay differences, be added to the aggregate cap. The commission’s monthly meeting resumes on Friday.

To contact the reporter on this story: Tony Pugh in Washington at tpugh@bloomberglaw.com

To contact the editor responsible for this story: Brent Bierman at bbierman@bloomberglaw.com

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