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MedPAC Mulls Direct Billing for Nurse Practitioners, Physician Assistants

Medicare would permit nurse practitioners and physician assistants to bill directly for their services under a proposal being considered by the Medicare Payment Advisory Commission.

Currently such services are billed as “incident to” physician services, but according to a report in Becker’s Hospital Review,

MedPAC staff told commissioners there are problems with “incident to” billing because it “obscures policymakers’ knowledge of who is providing care for beneficiaries,” “inhibits accurate valuation of fee schedule services,” and “increases Medicare beneficiary spending.”  Staff also said that physician assistants and nurse practitioners increasingly practice outside of primary care.

MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program.  While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in governing circles and its recommendations often find their way into legislation, regulations, and new public policy.

MedPAC commissioners are expected to vote on the recommendation next month.

Learn more about the billing recommendation in this article in Becker’s Hospital Review.

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues.

The issues on MedPAC’s December agenda were:

  • Medicare payments for physician and other health professionals services
  • payments for ambulatory surgical centers
  • payments for hospital inpatient and outpatient care
  • Medicare’s hospital quality incentive program
  • payments for skilled nursing facilities
  • payments for long-term care hospitals
  • payments for inpatient rehabilitation facilities
  • the Medicare Advantage program

MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program.  While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in governing circles and its recommendations often find their way into legislation, regulations, and new public policy.

Go here for links to the policy briefs and presentations that supported MedPAC’s discussion of these issues.

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues.

The issues on MedPAC’s October agenda were:

  • managing prescription opioid use in Medicare Part D
  • opioids and alternatives in hospital settings: payments, incentives, and Medicare data
  • Medicare payment policies for advanced practice registered nurses and physicians
  • Medicare’s role in the supply of primary care physicians
  • Medicare payments for services provided in inpatient psychiatric facilities
  • episode-based payments and outcome measures under a unified payment system for post-acute care
  • Medicare policy issues related to non-urgent and emergency care

Go here for links to the policy briefs and presentations that supported MedPAC’s discussion of these issues.

MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program.  While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in governing circles and its recommendations often find their way into legislation, regulations, and new public policy.

MedPAC Issues 2018 Report to Congress

The non-partisan legislative branch agency that advises Congress and the administration on Medicare payment policies has submitted its mandatory annual report to Congress.

Among the findings included in the report by the Medicare Payment Advisory Commission are:

  • Medicare’s hospital readmissions reduction program has not resulted in increases in emergency room visits or hospital observation stays.
  • Many Medicare accountable care organizations, while maintaining or improving quality, are producing more modest savings than predicted.
  • MedPAC approves of Medicare’s proposals to redesign the case-mix classification system for skilled nursing facilities.
  • MedPAC supports changes Medicare has proposed for patient assessment and therapy requirements for skilled nursing facilities.

MedPAC’s recommendations include:

  • Authorizing outpatient-only hospitals in isolated rural communities to ensure access to emergency care.
  • Reducing payments to off-campus emergency departments in certain urban areas.
  • Rebalancing Medicare’s physician fee schedule to increase payments for ambulatory evaluation and management services while reducing payments for procedures, imaging, and tests.
  • Paying for sequential stays in a unified prospective payment system for post-acute care.
  • Establishing new ways to help patients, families, and hospitals identify higher-quality post-acute care providers for their patients.
  • Establishing new principles for measuring quality that address both population-based measures and quality incentives.
  • Encouraging the development of managed care plans that better meet the needs of the dually eligible (Medicare and Medicaid) population.
  • Eliminating Medicare payment increases for skilled nursing facilities in FY 2019 and FY 2020 because of the healthy financial condition of those facilities.
  • Urging Medicare to use a uniform set of population-based measures for different health care settings and different populations.
  • Moving forward with a unified post-acute-care payment system as quickly as possible.

Learn more about MedPAC’s thinking, research, conclusions, and recommendations by consulting the following materials:   the news release that accompanied MedPAC’s transmission of its report to Congress; a fact sheet that accompanied the report’s release; and the 407-page report itself.

MedPAC Meets

The Medicare Payment Advisory Commission met last week in Washington, D.C. to address a number of Medicare reimbursement-related issues.

Among the subjects on MedPAC’s agenda were:

  • using payments to ensure appropriate access to and use of hospital emergency department services
  • uniform outcome measures for post-acute care
  • applying MedPAC’s principles for measuring quality: hospital quality incentives
  • Medicare coverage policy and use of low-value care
  • long-term issues confronting Medicare accountable care organizations
  • managed care plans for dual-eligible beneficiaries

While MedPAC’s policy and payment recommendations are not binding on Congress or the administration, its views are respected and influential and often become the basis for new public policy.

Go here to see the policy briefs and presentations offered to help guide MedPAC commissioners’ discussions about these and other issues.

MedPAC Meets

The Medicare Payment Advisory Commission, which advises Congress on Medicare payment issues, met last week in Washington, D.C.

Among the issues on MedPAC’s agenda were:

  • paying for sequential stays in a unified Medicare payment system for post-acute care
  • encouraging Medicare beneficiaries to use higher-quality post-acute care providers
  • using payment policy to ensure appropriate access to and use of hospital emergency department services
  • the Centers for Medicare & Medicaid Services’ financial alignment demonstration for dual-eligible beneficiaries
  • the effectiveness of the Medicare hospital readmissions reduction program
  • population-based quality measures such as preventable admissions and home and community days

Go here, to MedPAC’s web site, to see the issue briefs and presentations that supported the discussion of these issues.

MedPAC Meets

Last week the Medicare Payment Advisory Commission held two days of public meetings in Washington, D.C.

During the sessions MedPAC, a non-partisan legislative branch agency that advises Congress on Medicare payment issues, addressed the following subjects:

  • a Medicare Advantage status report
  • a Medicare prescription drug program (Part D) status report
  • hospital inpatient and outpatient payments
  • physician payments
  • ambulatory surgical center, dialysis center, and hospice payments
  • post-acute care facility payments
  • the hospital readmissions reduction program
  • telehealth
  • accountable care organizations

Go here to see the issue briefs and presentations used during the meetings.

MedPAC Meets

The Medicare Payment Advisory Commission met in Washington, D.C. last week.

Among the issues on the agenda of the independent agency that advises Congress on Medicare payment issues were:

  • payment adequacy for physicians and other health professional services
  • An alternative to the merit-based incentive payment system (MIPS)
  • payment adequacy for hospital inpatient and outpatient services
  • payment adequacy for ambulatory surgical center services
  • the status of the Medicare Advantage program

Find links to issue briefs on these subjects and the presentations offered at the meeting by going here, to the MedPAC web site.

MedPAC Meets

The independent agency that advises Congress and the administration on Medicare payment policies met last week in Washington, D.C.

Among the issues discussed at the meeting of the Medicare Payment Advisory Commission were:

  • the merit-based incentive payment system
  • telehealth
  • a redesign of Medicare’s hospital value incentive program

Many of the issues MedPAC addresses – including those noted above – are very important to private safety-net hospitals.

Find the presentations and issue briefs for these subjects and others discussed at the MedPAC meeting here, on MedPAC’s web site.

MedPAC Comments on Proposed Physician Fee Schedule

The Medicare Payment Advisory Commission has written to the Centers for Medicare & Medicaid Services to convey its views on CMS’s proposed revisions to Medicare physician payment policies for 2018.

Among the issues MedPAC addresses in its comment letter are proposed payments to physicians for nonexcepted items and services provided in nonexcepted off-campus provider-based hospital departments, the Medicare shared savings program, and the Medicare diabetes prevention program.

Return here later this week to learn about NAUH’s comment letter about the same proposed regulation.

See MedPAC’s comment letter here.