This Week in Washington DC – September 26, 2020

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

As you know, Medicare physician payments are scheduled to be cut when increases to evaluation and management (E/M) services are implemented next year. GI procedures are scheduled to be cut roughly 10%.

Thank you ACG Members! Over 160 U.S. House members signed the letter to HHS Secretary Azar and CMS Administrator Verma, urging them to address and prevent these reimbursement cuts in the CY 2021 Medicare Physician Fee Schedule. Your advocacy efforts are working. Click here to view the final letter.

Another Letter to House Leadership: We need you to urge your representatives to sign another letter currently being circulated in the House. This letter goes to House leadership. Reps. Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN) are leading this letter urging Congressional leaders to address the E/M and budget-neutrality issue in any upcoming legislation moving through the House. Why another letter? Congressional action begets more action. We need to continue this momentum. Please urge your representatives to sign this letter!

New CPT Code for Addtional COVID-19 Office Precautions: The American Medical Association (AMA) recently announced updates to the Current Procedural Terminology (CPT) code set. New CPT code 99072 can be reported for additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s). The code may be reported with an in-person patient encounter for an office visit or other non-facility service, in which the implemented guidelines related to mitigating the transmission of COVID-19. Also, use of this code is not dependent on a specific patient diagnosis. Click here to learn more.

Medicare Advanced Payment Program Updates: The U.S. House overwhelmingly approved a bipartisan bill late Tuesday to keep the government funded through early December and avoid a shutdown just before the November 2020 election. The U.S. Senate is expected to pass this bill as well. The House bill extends government funding from the end of the fiscal year on 9/30 to 12/11/2020. Included are changes to the Medicare Accelerated and Advanced Payment Program (AAP). These changes include a delay the recoupment of disbursed funds until 365 days after the advance payment has been issued to a physician practice, with the balance due by September 2022. It would reduce the per claim recoupment amount from 100% to 25% for the first 11 months, and then 50% of claims withheld for an additional six months. If practices are unable to fully repay advanced payments, the interest rate kicks in. However, under the bill, this interest rate would be lowered from 10.25% to 4%.

President Trump Signs Executive Order on Surprise Billing: President Trump highlighted some new health care policies during a speech in North Carolina on Thursday and signed an Executive Order with the goals of (1) more choice for consumers; (2) lower costs for families and seniors; and (3) better care for patients. The Executive Order addresses one of ACG’s top policy priorities -- surprise medical billing. The President also pledged to protect patients with pre-existing conditions and stated that he will not sign any health reform legislation that lacks these protections. President Trump further announced that in the coming weeks the Administration will also send cards worth $200 each to 33 million Medicare beneficiaries to help seniors pay for prescription drugs. This is estimated to cost $6.6 billion.

The Executive Order calls on Congress to reach a legislative solution on surprise billing by December 31, 2020. The order states that if no legislative solution is reached by the end of the year, HHS “shall take administrative action to prevent a patient from receiving a bill for out-of-pocket expenses that the patient could not have reasonably foreseen.”

The order also calls for HHS to update the Medicare.gov Hospital Compare website within 180 days to inform beneficiaries of hospital billing quality, including: whether the hospital is in compliance with the Hospital Price Transparency Final Rule (effective January 1, 2021); whether, upon discharge, the hospital provides patients with a receipt that includes a list of itemized services received during a hospital stay; and how often the hospital pursues legal action against patients (garnish wages, placing a lien on a patient’s home, or withdrawing money from a patient’s income tax refund). The Executive Order can be found here.