Volume 15, No. 11: November 2019 Edition

Surprise Bill on Medical Billing Moving Quickly in Pa. House	Old Medicare Numbers are DOA on January 1
AMA to Congress: "Do Something!"	Pa. Supreme Court Strikes Down Key Medical Liability Reform Measure
CMS Issues Final Rule for the 2020 Quality Payment Program	New Salary Levels Issued for Exempt Employees
Deadline Approaching for Enrolling in a Health Care Plan	Medicare Monthly Premiums Rise
Awards Season	Calendar of Events

The Philadelphia County Medical Society (PCMS) is calling on its members to contact their state representatives to object to the current form of HB 1862, which may be brought up for a vote later this month.

The bill would determine the out-of-network payment rate based on the median in-network rates. It would create a state-mandated price control not only for out-of-network care, but for all future negotiations between clinicians and insurance companies.

PCMS is asking its members to call or email your representative and encourage them to vote yes on two amendments to the bill:

• The Kaufer amendment (#A3599) would remove the median in-network rate as the state-mandated payment standard and put in its place "all reasonably necessary costs" which is the existing payment standard for emergency services in Pa. and has been for more than two decades.
• The Rothman amendment (#A3601) would call for an independent dispute resolution to look at whether the payment is appropriate. It also would encourage fair physician claims and insurer payments from the beginning. The current bill would only permit arbitration to look at the accuracy of the payment as determined by an insurer, with no checks or balances in place.

Click here to contact your legislator.

The Centers for Medicare and Medicaid Services (CMS) will no longer accept old Medicare numbers as of January 1, 2020. CMS has allowed both the old and new numbers to be used during a transition period, but that period ends on December 31.

CMS is allowing few exceptions after January 1. Claims using the old Medicare numbers after that date will be rejected no matter what date the service was performed.

If you don't have a patient's new MBI number, you can find it by going to your Medicare Administrative Contractor's (MAC) secure web portal.

Click Here for the MBI Lookup Tool for Pa. physicians.

The AMA says time is running out for Congress to take action to improve MACRA before the end of the year. The AMA has concluded that Medicare's Sustainable Growth Rate (SGR) formula is deeply flawed. If Congress does not act before the end of the year, physicians will face another year without an increase in Medicare payments.

While Medicare hospital pay has increased about 50% from 2001, Medicare physician pay has declined 19%. The AMA is calling on Congress to provide Medicare physicians with "a positive update by the end of the year."

To send a message to your US representative and senators, click here.

In Yanakos v. UPMC, the high court has struck down the portion of the MCARE Act which prohibited medical liability suits from being brought after seven years from the date of the alleged injury. Critics of the ruling say insurers will now have less certainty when it comes to medical liability, and that may lead to higher premiums on health care providers. Sky high premiums in the early 2000s led to passage of the MCARE Act.

The decision comes as a Pa. Supreme Court rules committee ponders whether to remove venue reform enacted under the MCARE Act. The measure stopped lawyers from shopping around for the most favorable state counties to take their medical malpractice cases. Supporters of the current law say if the reform is struck down, medical malpractice cases will flock to Philadelphia.

The 2020 performance year rule will maintain many of the requirements from 2019. It is also providing updates to both the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). CMS says the changes were made in response to clinician and stakeholder feedback, and to align with statutory requirements.

For details on the final rule, click here.

The U.S. Dept. of Labor has announced that effective January 1, 2020, the minimum salary for exempt employees will increase from $455 a week to $685 a week. That means that employees earning less than $685 a week are eligible for overtime.

The Dept. of Labor has issued a rule on what employers are required to do. You can find the rule here.

December 15 is the deadline for your patients to select a federally-funded health care plan for 2020. They can connect to a Marketplace-registered agent to help them enroll in a plan. Agents or brokers are trained and registered in their respective state. They're paid by insurance companies whose plans they sell, but they're required to act in the consumer's best interest.

If your patients would like help from an agent or broker they can go to this web page.

The 2020 Medicare Parts A (inpatient hospitals) and B (physician and outpatient services) premiums and deductibles are going up.

The Medicare Part B standard monthly premium is rising $9.10 to $144.60. and the annual deductible is increasing by $13 to $198. After the deductible is met beneficiaries typically pay 20% of the Medicare-approved amount for most doctor services. For more details, click here.

Now is the time to take stock of your friends and colleagues and decide who should be nominated for one of the Philadelphia County Medical Society's Annual Awards. Here's the list:

• Strittmatter Award - Honors a PCMS physician who has demonstrated the most valuable contributions to the healing art, surgical or medical. A physician colleague should submit a nominating letter that includes the candidate's current c.v.
• Practitioner of the Year Award - Honors a PCMS member for excellence in patient care and community service. Nominating letters from physician colleagues, medical students or staff, should include examples of community service.
• The Vanitha Appadorai Vaidya, MD Award for Humaneness in Medicine - Honors a PCMS resident/fellow physician who demonstrates exceptional skills in working with patients and their families, and understanding human as well as clinical needs. Nominating letters from physicians, professional staff or medical students, should include examples of nominee's humaneness.
• The Cristol Award - Honors a PCMS member who enhances the educational, scientific and charitable goals of organized medicine. Physician colleagues should submit a nominating letter.

Nominating letters should be emailed to [email protected], or faxed to 215-563-3627. For more information, call 215-563-5343, ext. 113. Deadline to submit Nominations is Friday February 28, 2020.

December

4 - Philadelphia Block Captains and Community Leaders CPR Training and Public Health Updates Date: Wednesday, December 4, 2019 Time: 5:30 PM - 8:00 PM Place: The Philadelphia County Medical Society, 2100 Spring Garden Street, Philadelphia, PA 19130 Attention Philadelphia Block Captains and Community Leaders! You're invited to participate in a "hands on" CPR training session led by Nabil Abdulhay, Project Coordinator and Ben Abella, MD, Professor of Emergency Medicine at the Hospital of the University of Pennsylvania and Medical Director of the Mobile CPR Project Team of Philadelphia. You will also hear important information and updates from the Philadelphia Dept. of Public Health, Philadelphia Corporation for Aging and the Philadelphia Regional Office of the Centers for Medicare and Medicaid Services. A free dinner will be available. RSVP by contacting Eileen Ryan at (215) 563-5343 x 113 or send an email to [email protected].