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Government Shutdown Averted

The Bipartisan Budget Act of 2018 was expected to focus on immigration, however, healthcare was the prevailing theme of the law that was passed on February 9, 2018. Highlights for medical practices include:

  • The elimination of the Independent Payment Advisory Board (IPAB), a group of 15 stakeholders who were empowered to take action to “save” money for Medicare; although the IPAB, which was created under the Affordable Care Act, had never even convened, the potential challenges from a board deciding the future of Medicare reimbursement had left many physicians on edge.
  • A decade of funding for the Children’s Health Insurance Program; further, community health centers – federally  funded quality health centers and rural health clinics – received not only an extension of funding, but more than a 10% boost.
  • An extension of the Work Geographic Practice Cost Index (GPCI) floor; a key component of the Medicare formula, this has positive implications for physicians practicing in more than 20 states, including Tennessee. Although the reimbursement boost won’t be enormous – Tennessee, for example, will rise from 0.976 to 1.0 – it will positively impact every procedure code billed to Medicare.
  • The permanent repeal of the Medicare payment caps for outpatient therapy services, to include physical and occupational therapies, as well as speech pathology.
  • A revision to the Merit-based Incentive Payment System, which was scheduled to impose a 30% performance score on eligible clinicians based on cost in 2019; the law extends 2018’s 10% scoring methodology for three more years although there is flexibility extended to the Centers for Medicare & Medicaid Services: “not less than 10 percent and not more than 30 percent.”
  • A pledge to evaluate reimbursement for longitudinal chronic care management, presumably expanding the coverage for transitional care and chronic care management; this study, however, will consume the next 18 months so reimbursement opportunities are not here yet, but on the horizon.

Finally, telehealth reimbursement is further expanded, adding telehealth benefits to Medicare Advantage patients, as well as expanding payment opportunities for accountable care organizations (ACOs) for telehealth.


About The Author

Elizabeth Woodcock is the founder and principal of Woodcock & Associates. She has focused on medical practice operations and revenue cycle management for more than 25 years. She has led educational sessions for a multitude of national professional associations and specialty societies, and consulted for clients as diverse as a solo orthopaedic surgeon in rural Georgia to the Mayo Clinic. She is author or co-author of 17 best-selling practice management books, to include Mastering Patient Flow and The Physician Billing Process: Avoiding Potholes in the Road to Getting Paid. Elizabeth is a Fellow in the American College of Medical Practice Executives and a Certified Professional Coder. In addition to a Bachelor of Arts from Duke University, she completed a Master of Business Administration in healthcare management from The Wharton School of Business of the University of Pennsylvania. She is currently a doctoral student at the Bloomberg School of Public Health of Johns Hopkins University.

The contents of The Sentinel are intended for educational/informational purposes only and do not constitute legal advice. Policyholders are urged to consult with their personal attorney for legal advice, as specific legal requirements may vary from state to state and/or change over time.

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