2017 Midwest AAOE Scholarship Winner:
Health Plans Can No Longer Charge Providers Egregious Fees for Electronic Fund Transfers
A recent survey by the Medical Group Management Association (MGMA) showed that 1 in 6 practices are paying fees for Electronic Fund Transfer (EFT), due to the payor using what is called a "Virtual Credit Card (VCC)" in order to accept electronic payments. These fees range from 2%-5% of the medical services payment.
MGMA has been working with CMS to change this and require that plans charge a more reasonable fee for EFT. This week, CMS released guidance on this issue.
Here's What You Need to Know
1. Health plans that are sending VCC payments must stop if a practice notifies the payor it wants to receive payments via EFT.
2. Plans cannot charge unsanctioned fees for the use of EFT. The amount must be similar to bank transaction fees - which are usually about 34 cents per transaction.
Signing up for EFT doesn't allow the plan to deduct funds from your account unless you have entered into a contract with the plan that allows them to do this.
Read more FAQs about EFT and VCCs on theCMS web site.
If you are an MGMA member, access the MGMA member-benefit EFT/ERAGuidefor more information and a sample letter to request payment via EFT.
Source: KarenZupko & Associates
July 13, 2017
CMS looks to drop payment for off-campus services by half
The CMS wants to drop by half what Medicare pays when patients receive healthcare at medical facilities that are owned by hospitals but located off their campuses.
The Obama administration last year finalized a rule that paid hospital off-campus facilities the same as hospital-based outpatient departments if they started billing Medicare after Nov. 2, 2015.
The proposal, outlined in the proposed 2018 physician fee pay rule released Thursday, would drop that rate from 50% to 25% of what they would have been paid under outpatient rates.
"At a time when the nation is moving toward value-based payments, this proposal makes no sense. In essence, it removes all incentives to provide care out in the communities rather than at the hospital, and ultimately will lead to higher overall Medicare spending," said Blair Childs, senior vice president of public affairs for Premier, a consulting firm.
The prioir, more generous payment made to off-campus facilities has led to hospitals acquiring physician practices at a rapid clip. But hospitals say the facilities, while increasing their operating costs, allow them to provide greater access to healthcare, especially in underserved areas.
The Trump administration's proposed changes would save $25 million next year. Among the services affected would include pain management treatment, some x-rays and radiation therapies as well as some behavioral health services.
"The CMS proposal will result in an unsustainable payment rate that will further reduce access for people in chronically underserved communities, health care deserts, and the hospitals on which they rely," Dr. Bruce Siegel CEO of America's Essential Hospitals said in a statement.
Congress passed what's called the site-neutral policy after a 2013 Medicare Payment Advisory Commission report that found Medicare was paying 141% more for a echocardiogram in an outpatient setting than for the same procedure in a doctor's office.
Comments on the proposed rule are due by Sept. 11.
Source: Modern Healthcare
Congressional Action Alert
CMS Action on Global Payments
Missouri says Aetna-Humana merger is anticompetitive
Missouri insurance officials have issued a preliminary order against the merger between health insurance giants Aetna and Humana, the first state to find a problem with the massive transaction.
Source: Modern Healthcare
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