Surprise Medical Billing Legislation

The surprise medical bill issue is at a key juncture in Congress.  The insurance industry is lobbying aggressively for a solution that is based on an artificially low “benchmark payment” to physicians set by and controlled by local insurance companies.  In contrast, ASA is working with our coalition of medical specialty organizations in support of a payment mechanism based on a market-based interim or automatic payment to physicians and a fair appeals or arbitration “backstop” model to contest unfair insurance practices.  Only one side will prevail.  It must be medicine, not insurance companies. What should you do to make your voice heard? Do the following things:

MIPS report cards now on Physician Compare Website

As part of CMS’s continued phased-in approach to public reporting on Physician Compare, the agency recently published a subset of 2017 QPP information submitted under MIPS and APMs. The information added on profile pages for MIPS eligible clinicians and groups includes select quality measure and CAHPS survey data.

To learn more about Physician Compare and the 2017 QPP data publication, review CMS’s fact sheet. MGMA Government Affairs encourages members to share feedback with us regarding their experiences with Physician Compare.

Call to action: Tell Congress to hold health plans accountable for surprise billing

In recent months, Congress introduced a number of bills that address the issue of surprise billing. There is widespread agreement that patients should be protected from surprise medical bills and taken out of the middle of payment disputes. However, the current legislative “solutions” give too much power to health plans.

2018 QPP performance results released

CMS has released data outlining preliminary, high-level results of participation data in the 2018 Quality Payment Program (QPP). A key takeaway from 2018 performance is that a higher percentage of participants in MIPS avoided a negative adjustment compared to 2017 performance (almost 98% versus 93%). Additional details of 2018 QPP participation include:

First year of MIPS payment adjustments

The start of 2019 marks the first time clinicians and practices that participated in the Merit-based Incentive Payment System (MIPS) will receive a payment adjustment based on 2017 performance. The Centers for Medicare & Medicaid Services (CMS) reports that 93% of 2017 MIPS participants will receive a positive payment adjustment of up to 1.88% this year.