Month: February 2022
Federal Judge Ruled in favor of TMA
Published 2/25/2022, Written by Kelsey Hagg, Associate Director Government Affairs MGMA
“In late 2021, the Texas Medical Association filed a lawsuit against the U.S. Department of Health and Human Services (HHS) alleging that the interim final rule establishing the qualifying payment amount (QPA) as the assumed out-of-network rate went against congressional intent and stating that all criteria (including the QPA) considered by the independent dispute resolution (IDR) entity should be weighted equally.
This morning a federal judge in Texas issued a motion for summary judgement ruling in favor of the Texas Medical Association.
The court determined that HHS violated the Administrative Procedures Act (APA) when issuing rulemaking establishing the QPA as the assumed out-of-network rate in the federal IDR process. This ruling means that if the higher courts don’t overturn or pause implementation pending appeals, we expect the IDR process to begin without the portions of the rule that were vacated.
Specifically, we expect the IDR process to begin without the QPA as the established out-of-network amount. Under this ruling, IDR entities do not have to select the payment amount that is closest to the QPA, nor do IDR entities have to describe the credible information that determined the QPA was materially different from the chosen out-of-network rate.
Additionally, we wanted to share information we received from CMS. In a call with the agency, a CMS spokesperson stated that they intend to open the federal IDR portal on Monday, February 28, 2022. However, this information is subject to change and we will keep you posted on any additional information we receive from the agency. Questions for CMS about the federal IDR process can be directed to: [email protected].
Please let us know if you have any additional questions.
Three Strategies to Recruit and Retain Your Primary Care Dream Team
Here are three creative approaches to recruiting and retaining top talent in today’s job market.
- Connect with local learning institutions.
- Consider alternative work schedules.
- Stand up a bonus program aligned with practice goals.
According to Evan Saulino, MD, PhD, a family physician and regional medical director at Aledade, the key is aligning value-based care work with your practice’s payment structure so staff members realize how their daily activities support quality care goals. “This also keeps the team focused on what they can do and not frustrated by what they can’t do,” Dr. Saulino said.
Some organizations award annual bonuses using a simple percentage, while others take a more nuanced approach. Dr. Saulino recommends incentivizing team members who are involved in value-based care work and who have completed a minimum tenure at the practice (e.g. a year of service). At the Walker Clinic, the bonus program unites clinical and nonclinical team members in tackling a given quality measure (e.g., mammograms), which is assigned a biannual bonus payment value. According to Walker, it’s this cross-functional alignment that’s been key to the clinic achieving shared savings.
“We all have to be on the same page and moving in a fluid motion, or we’re just not going to get there,” Walker said.
Surprise Billing FAQs, MGMA
Still confused about Good Faith Estimates (GFE)?
Does Qualifying Payment Amount (QPA) sound like Greek?
Superior Prior Auth Requirements
Superior will be ending any active prior authorizations for Synagis® effective February 1, 2022 for all Superior Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS) and CHIP members to align with HHS guidance. As the season has ended, claims for Synagis® will no longer adjudicate pursuant to the end of the season per VDP guidance.
Superior HealthPlan will require prior authorization for CPT code 81519, Oncology Breast MRNA, for Medicaid, CHIP and Superior HealthPlan Medicare-Medicaid Plan (MMP) members. Superior HealthPlan will utilize Change Healthcare’s InterQual as the medical necessity review criteria. Effective on May 1, 2022
Non-performers Impact on Performers
When an employee’s performance is consistently good, it becomes expected and may unknowingly be taken for granted.
I have seen people in leadership positions manipulate high-performing employees to produce more take on the burden of others while nothing is done to address the significant shortfall in the performance of other team members. At some point, this person will get burned out and lose all inspiration to continue performing at such a high level.
According to Tim McClure, when passionate employees become quiet, it usually signals that the work environment has become very dysfunctional. As a leader, this is something you must observe and act on immediately.
Please don’t push your most loyal people to the point that they no longer care. When you have people passionate, inspired, and motivated to help the company achieve its vision while fulfilling its purpose, you must do everything in your power to ensure that this team keeps this vibe. Otherwise, you run the risk of pushing away great talent while settling for mediocrity.
From LinkIn – Leadership First
The Power of the First Phone Call
“Patient satisfaction has become a key criterion by which to evaluate the
quality of healthcare services.
How make every call work for you.
Planning to Test for COVID?
You’ll Need a CLIA Waiver or Certification.
The fast-spreading omicron variant has pumped up demand for COVID-19 testing, and that means physician offices need to make sure they have obtained the correct waiver or certification from the U.S. government to administer those tests.
Quarterly Update for Clinical Laboratory Fee Schedule (CLFS)
Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment
CoVid-19 News from UHC
Beginning Jan. 15, 2022, UnitedHealthcare is covering the cost of Food and Drug Administration (FDA)-authorized or approved over-the-counter (OTC) at-home COVID-19 diagnostic tests for Individual and Family Plan and Individual and Group Market health plan members.
- The national public health emergency has been extended from Jan. 15, 2022 to April 15, 2022. See how that extension affects temporary provisions for COVID-19 testing and testing-related visits:
- Currently there are 2 monoclonal antibody and 3 antiviral treatment options authorized or approved for use.
- Reminder: CMS Billing change effective 1/1/2022.
- Health care professionals who administer the COVID-19 vaccine serum or monoclonal antibody treatment to Medicare Advantage members should submit medical claims through the UnitedHealthcare standard claims process.
- For services rendered through Dec. 31, 2021, claims should be billed to the applicable Centers for Medicare & Medicaid Services (CMS) Medicare Administrative Contractor (MAC), as previously established for reimbursement of these claims
Recent Comments