October Ebrief 2019

The Radiology Business Management Association (RBMA) introduced a new format for the 2019 Learn Conference by blending pre-conference webinars focusing on the major business issues facing radiology, high level briefings in Washington DC, and a “Hill Day” where conference attendees visited with over 50 Congressional offices on Capitol Hill. The pre-conference webinars addressed three major issues attendees would be speaking with members of Congress and Congressional staffers about, specifically Surprise Billing Legislation, Date of Service (DOS) Reporting, and the Center for Medicare and Medicaid Services’ (CMS) changes to Evaluation and Management (E & M) payments under the proposed 2020 Medicare Physician Fee Schedule (MPFS).

Surprise Billing Proposed Legislation
The No Surprises Act, co-authored by Energy and Commerce Committee leaders Rep. Frank Pallone (D-NJ) and Rep. Greg Walden (R-OR would prohibit balance-billing patients and establish commercial health plan payments based on each health plan’s median in-network rates. Initially, the No Surprises Act did not include an Individual Dispute Resolution (IDR) process for providers and payers to challenge the median reimbursement. However, on July 17th, the Committee passed the No Surprises Act with the addition of an arbitration process for resolving some out-of-network payment disputes.

The Senate has also introduced two surprise-billing Acts, the Lower Health Care Costs Act, introduced by Sen. Lamar Alexander (R-TN) and Sen. Patty Murray (D-WA) and the STOP Surprise Medical Bills Act, introduced by Sen. Maggie Hassan (D-NH), Sen. Bill Cassidy (R-LA), and a bipartisan group of senators. Like the House version, the Lower Health Care Costs Act would require health plans to pay providers the local, median in-network contracted amount. And also like the House, the STOP Surprise Medical Bills Act includes an IDR process for out-of-network payment conflicts between providers and payers.

Concerns set forth by RBMA Members during “Hill Day” included a) the potential for rate-setting to impede a fair in-network negotiation between radiology groups and payers, b) the median payment does not consider site acuity, c) a threshold of $1,250 for initiating an IDR process disadvantages radiology, since, according to an RBMA survey, 80 percent of patient bills are less than $200, and d) the requirement that patient statements be received within 45 days from the date of service does not allow time for payer adjudication, most notably in a hospital-setting.

DOS Reporting
The RBMA has been struggling with CMS over the date of service for professional interpretations for over a decade and this issue has been further complicated by the issuance of conflicting guidance by Medicare carriers. Current CMS guidelines state the date of service for the professional component is the date the interpretation was rendered. However, according to a March 2019 RBMA survey, 89 percent of respondents are reporting the technical service date as the date of service for the professional component. To complicate matters further, a majority of commercial payers use the date the image is captured as the DOS for the professional interpretation. The “ask” from RBMA members during “Hill Day” was for CMS to give radiologists the option of reporting either the date the technical exam was performed or the date the professional interpretation was rendered as the DOS for the professional interpretation. Congressional members and staffers were asked to send letters or make calls to CMS in support of this position.

Changes to Evaluation and Management Payments under the Proposed 2020 Medicare Physician Fee Schedule
CMS has proposed that all five levels of E & M CPT® codes be paid separately for established patients and a four-tier coding system for new patients, as opposed to blending rates for certain levels, which was finalized in the 2019 MPFS Final Rule. CMS is also proposing to adopt the AMA’s CPT® Editorial Panel’s revised E & M code definitions beginning Jan. 1, 2021. These code changes would revise the time and decision-making guidelines for each level and would require documentation of patient history and a medical exam only when clinically appropriate. Providers would be allowed to choose visit levels based on the extent of decision-making in the exam or based on time spent with the patient.

CMS has also proposed adopting the AMA’s RUC-recommended payment rates, which are based on a survey of 50+ specialty types. The survey shows office/outpatient E & M visits are typically more complex and require additional resources. This change means CMS would not blend code levels 2 through 4 but would make payments based on each level of service.

An estimated $5 billion dollars will be needed from other specialties to satisfy these proposed changes to remain budget neutral and the impact to radiology would be an approximate eight percent decrease in payments. Congressional members and staffers were urged to limit the negative impact on specialties such as radiology and to reconsider budget neutrality during “Hill Day.”

The week of September 16th was the first week of House and Senate Committee meetings before the upcoming January legislative session.

Speaker designee Chris Sprowls was officially designated by the House Republican caucus.

The meetings this week were fairly quiet. Amy Baker, Florida’s Chief Economist presented a tight budget forecast in both her House and Senate presentation, predicting a $867 million short fall in revenues coming into the state coffers. The main topics were gun safety, mental health issues, the Secretary of Health presenting to the Senate and House committees on the Hepatitis outbreak, and the opioid issue. There was a brief presentation by the Department of Health on implementation of Telehealth before the House Health Quality Committee.

The House and Senate will be holding their next set of committee meetings the week of October 14th-18th and October 21st-25th. The week of October 21st-25th will also be a Special Session. Senate President Galvano called a special session in response to the Special Masters report on Broward County Sheriff Israel. The Legislature is to vote on the Special Masters report to reconsider Sheriff Israel’s suspension and reinstate him as Sheriff of Broward County. Due to them being in Special Session that week, there will be no fundraiser’s for sitting members.

Please feel free to contact me with any questions.

Florida Radiological Society is pleased to introduce the opportunity for interested parties to advertise for potential jobs in our monthly FRS Ebrief bulletin.

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