The American Medical Association (AMA) has summarized its 2023 lobbying goals based on several themes, which include the following five themes: fixing prior authorization, improving public health, promoting physician-led care, supporting telehealth, and reducing physician burnout.
First, to improve prior authorizations, the AMA reports that it successfully convinced the Centers for Medicare & Medicaid Services (CMS) to right-size the prior authorization process imposed by Medicare Advantage plans on medical services and procedures, which is demonstrated in a recent final rule.
The AMA also reports that it worked in partnership with state medical associations across the country to enact prior authorization reform using AMA model legislation, data, testimony and other resources. More than 30 states have introduced such legislation this year alone.
Second, to improving public health, the AMA encouraged the administration to provide flexibility in the Special Supplemental Nutrition Program for Women, Infants, and Children (also known as WIC) Food Packages to better reflect cultural and medical needs and personal preferences while promoting growth and health in women and children.
In another effort to improve public health, the AMA advised the U.S. Department of Agriculture to revise its Child Nutrition Programs to limit the fat, added sugar, and sodium content in school-based food programs, and accommodate food substitutions based on cultural and medical needs and preferences.
Third, to promote physician-led care, the AMA reported it worked to defeat legislation that would have allowed Physician Assistants to practice independently without physician oversight, allowed pharmacists to prescribe medications, and also would have allowed optometrists to perform surgery.
Forth, to support telehealth, the AMA achieved passage of legislation to extend Medicare telehealth coverage, including audio-only and hospital-at-home services, through 2024.
Fifth, to reduce physician burnout, the AMA has advocated for and supported new laws and policies in 7 states to protect physicians who seek care for wellness and burnout.
In other news, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS)recently conducted an audit with results showing that Medicare overpaid by approximately $22.5 million as a result of incorrect place-of-service coding. Place-of-service coding is a two-digit code to inform where services were rendered, such as the hospital, a surgery center, or a skilled nursing facility.
For the years of 2019 and 2020, the OIG identified a total of 2.1 million physician service claims at risk of incorrect payments due to noncompliance with CMS policies. Further, the OIG found that Medicare overpaid by over $22 million dollars for over one million claim lines by paying the non-facility rate for services coded as provided in a nursing facility or skilled nursing facility setting without Part A coverage while Part A enrollees were inpatients at Skilled nursing facilities.
As a result of the audit, OIG recommended that CMS take six steps to improve. The steps include the following:
- First, direct its Medicare contractors to recover the overpayments.
- Second, notify practitioners found to be incorrectly coding services to educate them on proper policy and have them report and return overpayments received.
- Third, establish procedures that can detect future place-of-service coding errors related to Skilled nursing facilities.
- Forth, revise regulations to ensure that Medicare appropriately pays for physician services at Skilled nursing facilities.
- Fifth, consider developing a system that would alert facilities when an inpatient leaves a facility and returns the same day.
- Sixth, provide additional educational material pertaining to appropriate place-of-service coding.
CMS agreed to comply with recommendations one, two, three and six, and said that the additional recommendations would be considered “along with other available information” to determine whether further action is needed.
