Medicaid Enrollment Will Likely Be Impacted by Unwinding Period

All states began unwinding Medicaid continuous enrollment beginning on April 1, 2023. With the adoption of the continued enrollment provision in March 2020, millions of Medicaid beneficiaries have been protected from losing their coverage over the past three years. Because states were prohibited from disenrolling people from Medicaid in exchange for enhanced federal funding, enrollment in the program has grown by an estimated 23 million to reach 95 million as of the end of March 2023. After concluding continuous enrollment, states will redetermine Medicaid eligibility over the next year (and more quickly in some states) and disenroll those no longer eligible. They will also disenroll those who remain eligible, but face challenges in completing the renewal process. Millions of people are expected to lose Medicaid coverage nationally.

State policy choices and variations in administrative infrastructure will influence how the unwinding of the continuous enrollment provision plays out. Some states have adopted multiple policies to promote the continuation of insurance coverage for eligible individuals. Others have adopted fewer policies, likely leading to more people losing Medicaid coverage, including some who remain eligible. Additionally, some states have automated eligibility systems that can more easily and accurately process renewals, reducing the number of renewals staff must complete manually.

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Medicare Pay Revisions Ignite Physician Unification

Amidst many impactful healthcare issues, some progress has been made in Medicare. Reforming Medicare physician payment has been the subject of months of high-level discussions. As a result, physician lawmakers introduced bipartisan legislation advancing the first leg of the AMA's three-part strategy for fixing the broken system.

The "Strengthening Medicare for Patients and Providers Act," H.R. 2474, would automatically

update physician Medicare payment rates and link them to inflation.

Linking updates to the Medicare Economic Index is "the cornerstone of building a sustainable payment system that could continue to guarantee access to quality care for beneficiaries," AMA

Senior Vice President of Advocacy Todd Askew said in a recent episode of "AMA Update."

Over the period 2001 to 2023, physician payments fell by 26%, capped off most recently by a 2% pay cut in 2023. Small, independent, and rural physician practices, as well as doctors serving economically marginalized and historically marginalized racial and ethnic groups, are disproportionately affected by diminishing operating margins.

The Medical Community Stands United

In support of the AMA's legislation, nearly 120 physician associations and healthcare organizations signed the letter to the physicians in Congress.

Congress introduced the bill in response to a recommendation from the Medicare Payment Advisory Commission (MedPAC) to increase 2024 Medicare physician payments over current law through the use of the Medicare Economic Index as a basis for updating Medicare physician payments. Concurrently, the Medicare Trustees Report issued a report last month saying that lawmakers should “expect access to Medicare-participating physicians to become a significant issue in the long term,” unless Congress takes steps to bolster the payment system, the joint letter notes. 

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The Importance of a Compliance Plan and Internal Audits

By Nicole Benson, Gill Compliance Solutions

Several years ago, CMS implemented the Targeted Probe and Educate (TPE) audit process, designed to be a friendly audit to reduce denials and appeals while improving its administrative process.

While the process sounded helpful to practices, it hasn’t lived up to its goals per the AMA. TPE ties physicians and their practices to Medicare Administrative Contractors (MACs), who are tasked with helping them identify and correct errors. But the process is onerous, requiring a lot of time to prepare supporting documents for MAC review, which can then lead to broader and more complicated audits. These audits can take up to two years to resolve, and there have been increases in the past year.

Commercial payor audits, meanwhile, can be even harder to navigate. Many contracts have not been updated in years, and commercial audits are based on contracts with unique opportunities for denial, rate changes, and termination. All have the propensity to hold up claims and reimbursement for services.

By establishing and following an internal compliance plan, providers can better safeguard against TPE and payer audits while ensuring clean claims submission and more accurate documentation practices. The following seven components provide a solid basis upon which a physician practice can create a voluntary compliance program:



• Implementing written policies, procedures, and standards of conduct
• Designating a compliance officer and compliance committee, both with experience and training/certifications
• Conducting effective training and education
• Developing effective lines of communication
• Conducting internal monitoring and auditing
• Enforcing standards through well-publicized disciplinary guidelines
• Responding promptly to offenses and undertaking corrective action

While internal compliance and auditing can take time and money for practices, the overall benefits far outweigh the alternatives. According to the AMA, audits should help to determine outliers and/or variations from the national averages, protect against fraudulent claims and billing; identify and correct problem areas before insurance or government payers challenge inappropriate coding; remedy under-coding, over-coding, upcoding, unbundling habits, code overuse; discover documentation deficiencies, while identifying payment deficiencies and opportunities for appropriate payment. 

Your investment of time and resources upfront is guaranteed to provide a more knowledgeable practice and discover areas of opportunity, while reducing the clinic’s risk of cumbersome payer audits and possible financial hardship. All a return on initial investment!

Idaho Psychiatric Association 2023 Annual CME Conference taking place May 12th, 2023. Practitioners and the public of all types are welcome and encouraged to attend! Also included with registration, IPA will host a fun after-party with bowling, pool, networking, drinks, and appetizers. If your family would also like to join, they are more than welcome; it is just $25/person for an extra ticket.

Our theme this year is “ADVOCACY AND BEYOND -- THE INTERSECTION OF STIGMA, BIAS, AND GUN CONTROL,” and we have two national renown speakers with a great line-up of topics, including:

• Anti-Racism / Bias
• Advocacy 101
• Balancing Threat Assessment and Risk Management within the Mental Health Framework
• How to Talk to Our Community About Firearm Risk and Mitigation Strategies
• Climate Change and Its Myriad Effects on Mental Health

Please contact Mike Oster at mike@idmed.org or 208-344-7888 ext.102 with questions.