The Medicare Payment Advisory Commission Friday issued its June report to Congress, which includes several recommendations approved by the panel during its January and March meetings. Specifically, the report recommends 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.
  •  require advanced practice registered nurses and physician assistants to bill the Medicare program directly, eliminating “incident to” billing for services they provide, and that the HHS Secretary refine Medicare’s specialty designations for APRNs and PAs.
  •  direct the HHS Secretary to establish thresholds for the completeness and accuracy of Medicare Advantage 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. 

The Medicaid and CHIP Payment and Access Commission also issued its June report to Congress Friday, which includes a recommendation approved at its recent meeting that Congress change the definition of Medicaid shortfall to exclude costs and payments for all Medicaid-eligible patients for whom Medicaid is not the primary payer.

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