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In this Issue...
- National Study to Document Physician Practice Expense
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IMA Annual Meeting Registration ~ NOW OPEN
- Idaho Diabetes, Heart Disease, and Stroke Prevention (DHDSP) Program Funding Opportunities
- Hospitals Ask Congress to Delay ACA Medicaid Funding Cuts — For the 14th Time
- Soar Works Idaho
- Navigating Disability Benefits
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CMS Discarded Drug Policy Update - Effective July 1st
- Depolarizing Conversations in Healthcare
- Order Your 2023 IMA Directory of Idaho Physicians Today!
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National Study to Document Changes in Physician Practice Expense
The American Medical Association (AMA) is undertaking a new national study, supported by 173 healthcare organizations, to collect representative data on physician practice expenses. The Physician Practice Information (PPI) Survey aims to better understand the costs faced by today’s physician practices to support physician payment advocacy. The study will serve as an opportunity to communicate accurate financial information to policymakers, including members of Congress and the Centers for Medicare & Medicaid Services (CMS). The AMA has contracted with Mathematica, an independent research company with extensive experience in survey methods as well as health care delivery and finance reform, to conduct the study.
The Medicare physician payment schedule, maintained by CMS and used by many other payers, relies on 2006 cost information to develop practice expense relative values, the Medicare Economic Index, and resulting physician payments. As the U.S. economy and healthcare system have undergone substantial changes since that time, including inflation and the widespread adoption of electronic health records and other information technology systems, practice expense payments no longer accurately reflect the relative resources that are typically required to provide physician services.
The study will rely on financial experts in the practice to complete an online financial information survey. The number of direct patient care hours is a critical component of the Medicare payment methodology. Therefore, thousands of individual physicians will receive a short patient care hours survey from either their practice directly or from Mathematica. The input from physician practices and individual physicians randomly selected to participate in this study is critical for its success. Participation will ensure that practice expenses and patient care hours are accurately reflected.
Practices will be contacted via mail and email.
- The subject line for the PPI Survey invitation email will read, “American Medical Association requests your input on physician practice expense and patient care hours”. The subject line for the Physician Hours Survey invitation email will read, “Please help to update accurate physician payments”.
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Invitations and reminders about the PPI Survey, sent to financial experts in the practice, will come from PPISurvey@mathematica-mpr.com.
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Invitations and reminders about the Physician Hours Survey, distributed to physicians, will come from PhysicianHoursSurvey@mathematica-mpr.com or from the practice directly.
Please contact sherry.smith@ama-assn.org with any questions related to the PPI Survey or Irene Butler ibutler@asecho.org if you would like some background information.
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IMA Annual Meeting Registration ~ NOW OPEN
The 2023 IMA Annual Meeting registration link is now LIVE on our website! There are several ways to participate in this year’s meeting.
Ways to Attend Annual Meeting
For the first time, participation in this year’s House of Delegates (HOD) meeting will be offered in new ways for members to engage in the policy-making process.
Want to attend the meeting in-person?
- Select “In-Person Registration - Fri/Sat/Sun.” Members can register to attend the meeting in-person for all three days of the meeting.
Can’t attend the meeting in-person, but still want to participate?
- Select “Virtual Registration - FRIDAY ONLY.” NEW this year, members can attend and provide testimony for resolutions virtually on Friday!
Need a hybrid option?
- Select “Hybrid Registration - Fri Virtual, Sat and/or Sun In-Person.” Register to attend virtually on Friday and in-person on Saturday and/or Sunday.
Can’t attend the meeting this year in-person or virtually?
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Members who cannot attend the meeting this year can provide written testimony on resolutions prior to HOD via our “Early Testimony” tool. Please watch for an email in September when this tool becomes available. HOD resolutions and reports will be posted on Wednesday, September 13th.
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Funding Opportunities Now Available!
The Idaho Diabetes, Heart Disease, and Stroke Prevention (DHDSP) Program is pleased to announce the release of two (2) funding opportunities for Idaho organizations to:
- Implement or expand Diabetes Self-Management Education and Support (DSMES) programs for priority
- Expand the National Diabetes Prevention Program (National DPP) for priority populations with prediabetes.
The Idaho DHDSP Program seeks to fund up to six (6) organizations during the 2023 – 2024 award year (September/October 2023 – June 29, 2024); up to $16,000, per applicant organization. Up to three (3) will be awarded to implement or expand DSMES programs and up to three (3) organizations will be awarded to expand the National DPP.
Interested organizations can access the funding opportunity announcement and application on our website by clicking the "Learn More" button below.
Applications are due by 5:00 pm MDT on Monday, August 14, 2023.
Email completed applications or questions to the Idaho DHDSP Program, DHDSP@dhw.Idaho.gov.
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Hospitals Ask Congress to Delay ACA Medicaid Funding Cuts — For the 14th Time
by KFF Health News
It has become as familiar a sight in Washington as the cherry blossoms in spring: lobbyists from the nation’s hospitals descending on the Capitol to ask lawmakers to postpone billions in Medicaid funding cuts prescribed by the Affordable Care Act — cuts industry leaders agreed to years ago.
It is unlikely the reductions will occur this year if history is any indication. Since 2013, Congress has voted 13 times to delay them, siding with hospitals over their claims that losing the money would hinder the delivery of care.
Unless Congress acts by October, the federal government will cut $8 billion from this year’s budget — then make the same cut each year for the next three years — for a Medicaid program intended to help safety-net facilities that serve a large share of Medicaid and uninsured patients. The amount budgeted varies annually, though in 2021 the program’s spending totaled about $19 billion.
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Learn About Your Role in Assisting Patients Seeking Disability
Front-line health care professionals are in a unique position to impact the disability process but often do not have specialized training in managing patients with diminished work capacity.
This free webinar will provide introductory concepts to help navigate and negotiate disability systems. The webinar will reference best practices from the book, AMA Guides to Navigating Disability Benefits Systems.
Join experts in disability systems to glean a better understanding of how to:
- Promote health by promoting work.
- Understand your role in assisting patients seeking disability.
- Communicate with patients, employers, and insurers
- Provide meaningful documentation.
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CMS Discarded Drug Policy Update - Effective July 1st
By Jana Weis, Gill Compliance Solutions
The Medicare policy over discarded drugs and biologicals was originally implemented in January of 2017 to standardize tracking of waste and lead to the recoupment of money from pharmaceutical manufactures, while providing discarded drug refunds to providers and clinics for their incurred expenses. However, the -JW modifier to report this waste was underutilized, leading to the July 1, 2023 policy update and implementation of Modifier -JZ, zero drug amount discarded.
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| MODIFIER | SHORT DESCRIPTOR | LONG DESCRIPTOR | | JW | Discarded drug not administered | Drug amount discarded/not administered to any patient | | JZ | Zero drug wasted | Zero drug amount discarded/not administered to any patient | | |
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The discarded drug policy (A55932) is applicable to all providers and suppliers (i.e., pharmacies) who purchase and bill separately payable drugs under Medicare Part B for single-dose containers of medication and biologicals. “When a provider must discard an amount of drug from a single-dose container after administering a dose to a Medicare beneficiary, CMS provides payment for the discarded amount, as well as the dose administered, up to the amount of the drug indicated on the vial or package labeling.” Both the -JW and -JZ modifiers are only reported on claims by attaching them to the appropriate medication code (HCPCS J codes) involving a single-dose vial or container with a few exceptions listed below. These modifiers are also required as applicable under the policy to indicate discarded drug or no drug waste.
The units billed on the claim must correspond with the smallest dose (vial) available for purchase from the manufacturer(s) providing the appropriate patient dose, while minimizing any waste. For example: Patient required a 350mg dose of Infliximab and the office purchased 4 (100mg single dose vials) equaling 400mg. Infliximab (Remicade) J1745 is billed per 10mg:
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| HCPS / Modifier | Units Billed | Explanation | | J1745 | 35 | First link, actual administered - no modifier | | J1745-JW | 5 | Second line, unused waste - appending modifier JW | | |
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Be sure to document the discarded drug or biological in the patient's medical record along with the appropriate drug administration and supply purchasing. The CMS expectation is that “providers and suppliers will maintain accurate (medical and/or dispensing) records for all beneficiaries as well as accurate purchasing and inventory records for all drugs that were purchased and billed to Medicare. CMS has no specific requirements regarding the method, format, the medical staff responsible for making the record, or location of discarded amount data in a patient's medical record.” It is recommended to verify policies with private payers and Noridian.
Items / services that are not covered under this policy include:
- Not separately payable (i.e., packaged Outpatient Prospective Payment System (OPPS) or Ambulatory Surgical Center (ASC) drugs
- Administered in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC)
- Overfilled amounts (any amount of drug greater than the amount identified on the package or label
- Vaccines / immunizations
Please note that claims received by Medicare after July 1st without the appropriate -JW or -JZ modifier on single-dose medications will be subject to audit. And after October 1st, these claims will be returned as unprocessed and unreimbursed.
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