MedPAC calls for ED visit coding guidelines, MA encounter data thresholds

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.