CMS Resolving Mistake on 2019 MIPS Payment Adjustments

From ACG Legislative and Public Policy Council Chair, Whitfield L. Knapple, MD, FACG

This week, CMS announced that physicians are incorrectly receiving 2019 MIPS payment adjustments on certain services that should be excluded from any payment adjustment, including Medicare Part B drugs. ACG was made aware of this issue, and worked with like-minded organizations to develop a resolution. CMS noted that the agency is working with their contractors to resolve the issue:

“Q: Should payments for Medicare Part B drugs be included in the 2019 MIPS Payment Adjustment?

A: On February 9, 2018, Congress passed the Bipartisan Budget Act of 2018, which contained provisions that made several changes to the Merit-based Incentive Payment System (MIPS) track of the Quality Payment Program, including no longer calculating the cost of Part B drugs in the low volume threshold.
Recently, CMS discovered an error in the 2019 MIPS payment adjustment applied by the Medicare Administrative Contractors (MACs), which included the payments for Medicare Part B drugs.

At this time, the Center for Medicare and Medicaid Services (CMS) is unable to provide an exact date of when impacted clinicians will see the update and correction, but we anticipate an adjustment in the near future. In the event that CMS overpaid a claim based on inclusion of the Medicare Part B drugs, a notification for recoupment will be issued from their MAC on behalf of CMS. 
CMS is working as quickly as possible to resolve this issue. No further action is requested of clinicians. CMS sincerely apologizes for any inconvenience this error may have caused.”

ACG will continue to work with CMS to ensure members’ Medicare reimbursement claims are properly paid, and will update members as more information becomes available.

Updated ACG Membership Tool: Medicare Reimbursement Chart for Selected GI Services

From ACG Practice Management Committee Chair, Louis J. Wilson, MD, FACG

As ACG and the GI societies alerted members late last year, CMS released the calendar year (CY) 2019 Medicare Physician Fee Schedule (PFS) final rule, which includes several significant policy and payment changes for ACG members.

Review the GI societies’ comprehensive summary of key issues for GI practices.

ACG and the GI societies also provided a CY 2019 Medicare national average reimbursement chart for selected GI procedures.

Check it out here.

Congress Begins ACA Hearings- More on the Calendar

Congress held its first hearing on the Patient Protection and Affordable Care Act (ACA) since the Democrats gained back the majority of the U.S. House of Representatives.  On Wednesday, a hearing was held by the House Appropriations Committee’s Labor-Health subcommittee to review various initiatives by the Trump Administration, described by Chair Rep. Rosa DeLauro (D-CT) as a consistent process of damaging and undermining the ACA, including decreasing funding for enrollment outreach and assistance, and terminating cost-sharing reduction payments to insurers.

Republicans responded by pointing to the rising insurance premiums and lack of insurer options in many areas nationwide.  Republicans also discussed the importance of short-term insurance and association health plans, that are designed to offer less expansive options for certain patients willing to go with less comprehensive coverage.

This is the first of what policy wonks believe will be many hearings on the ACA.  Next week, the House Energy & Commerce Committee will hold a hearing on the ACA and its impact on patients with pre-existing conditions.  ACG has consistently held that the ACA’s impact on patients with pre-existing must continue to remain in place, as Congress works to improve other ACA issues related to cost-sharing and physician reimbursement.