The Medicare Payment Advisory Commission today voted to recommend 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 lieu of the current Centers for Medicare & Medicaid Services’ instruction for hospitals to develop their own internal guidelines for these services.

In other action, the commission voted to recommend that Congress direct the HHS secretary to encourage Medicare Advantage plans to submit complete and accurate encounter data to help inform payment policy making. Specifically, it said HHS should 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 individual MA organization does not meet the thresholds or chooses this option, or for all MA organizations if program-wide thresholds are not achieved.

Other topics discussed at the meeting include how to expand the use of value-based payment in Medicare, evaluate performance in the Medicare Shared Savings Program, redesign the MA quality bonus program, improve affordability of Part D specialty drugs and biologics, and improve payment for low-volume and isolated outpatient dialysis facilities. The commission also discussed the consistency of patient functional assessment data between and within post-acute care providers.
 

Related News Articles

Headline
The House Budget Committee today held a hearing on the Congressional Budget Office’s recent report on key design components and considerations for policymakers…
Headline
The Centers for Medicare…
Headline
The AHA today responded to a RAND Corporation study that found that certain prices paid to hospitals by private health plans are high relative to Medicare and…
Headline
A federal district court judge yesterday ruled that the Department of Health and Human Services would get "first crack at crafting appropriate remedial…
Headline
The Centers for Medicare…
Headline
Reps. Rosa DeLauro, D-Conn., and Jan Schakowsky, D-Ill., this week introduced the Medicare for America Act, legislation that would create a national health…