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Regs & Eggs - July 29, 2019

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BREAKING NEWS: Major Medicare Payment Rule Adjusts Value of Emergency Medicine Services

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The Centers for Medicare & Medicaid Services (CMS), the agency responsible for running Medicare and Medicaid, just issued their proposed Medicare physician fee schedule for 2020. The rule includes proposals that affect Medicare payments—which serve as the basis for which many private payers set their reimbursement rates.  

As expected, CMS included a proposal to revalue the ED Evaluation and Management codes—the most commonly billed services for emergency physicians.

ACEP advocated strongly through the American Medical Association’s RVS Update Committee (RUC)—the established process for the medical community to develop values for physician service codes and provide formal recommendations to CMS. ACEP surveyed members and presented the results along with a rationale for values that would more appropriately account for the intensity and time of the services being delivered in the emergency department (ED). And fortunately, the RUC accepted ACEP’s recommendation. 

ACEP has a tough job at the RUC.  Because of the budget neutrality requirement under the Medicare physician fee schedule, any increases in the value of one code means a corresponding decrease in the value of all other codes. Therefore, each specialty must provide a compelling enough argument to convince at least two thirds of the other RUC voting specialties to support the recommended value.

We are happy to announce that CMS is proposing to accept the RUC’s recommended values. If finalized, this revaluation would increase Medicare reimbursement for ED visit codes by approximately $137 million in 2020, when the policy becomes effective. The increased values would become the new standard for each year after that.

The proposed rule includes numerous other proposals that will affect you.  Stay tuned for updates, and enjoy reading regs with your eggs!

jeff headshot.PNGIf you have any questions or want to weigh in on other regulatory items, feel free to email me: jdavis@acep.org.

Jeffrey Davis is the Director of Regulatory Affairs at the American College of Emergency Physicians (ACEP). He manages ACEP’s formal response to federal policies and works with federal agencies and other stakeholders to help advance ACEP’s federal affairs agenda. Prior to that, Jeffrey worked in the Budget Office at the U.S. Department of Health and Human Services for nearly eight years. Jeffrey came to the Government as a Presidential Management Fellow, and in his position in the Budget Office, he advised top level officials on major budgetary and policy considerations within Medicare and prepared detailed analyses of Medicare regulations and legislation. Jeffrey has a Masters of Science in Health Policy and Management from the Harvard T.H. Chan School of Public Health and a Bachelors of Arts degree from Duke University.

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