MedPAC discusses ED visit coding, MA encounter data

The Medicare Payment Advisory Commission this week discussed a draft recommendation that Congress direct the Health and Human Services Secretary to develop and implement by 2022 a set of national guidelines for coding hospital emergency department visits in response to the shift in ED coding from lower to higher intensity services over time. The commission also discussed a draft recommendation to encourage Medicare Advantage plans to submit complete and accurate encounter data to Medicare to help inform payment policy making, which would direct the HHS Secretary to establish thresholds for the completeness and accuracy of MA encounter data; evaluate MA organizations’ submitted data and provide feedback; apply a payment withhold to MA organizations that do not meet the thresholds and refund to those that do; and by 2024, establish a mechanism for providers to submit claims directly to the Medicare administrative contractors if an MA organization does not meet the thresholds or chooses this option. MedPAC is expected to vote on the draft recommendations at its April meeting.
 
Other topics of discussion at the meeting this week included the use of reference pricing and binding arbitration as strategies to address Medicare Part B drug spending; Medicare’s role in the supply of primary care physicians; the potential of a unified post-acute care prospective payment system; and congressionally-mandated reports on clinician payment and the impact of long-term care hospital payment structure changes on PAC. The commissioners guided MedPAC staff to continue pursuing a stay-based approach (rather than an episode-based approach) in their development of a unified PAC PPS model, and received an update on the implementation of site-neutral payment for LTCHs.