MGMA Asks CMS to Rescind New Payment Rule

The Medical Group Management Association is asking the Centers for Medicare and Medicaid Services to rescind its new “three-day rule” for Medicare payment of certain physician services.

These are services given within a hospital-wholly owned or operated physician practice within three days prior to an inpatient admission and related to the admission. Under the rule, hospitals must notify the practices of such admissions. The practices would include a modified code on claims for treatment during the three days prior to admission and the claims would be paid at a lower rate.

For your consideration: MGMA has recently weighed in about the national plan identifier, eRX program deadlines and proposed ICD-10 delays.

CMS delayed reimbursement changes for six months until July 1 in recognition that hospitals and practices needed more time to coordinate billing and accounting processes and information systems. MGMA in a letter to CMS Acting Administrator Marilyn Tavenner wants the policy rescinded because of needless burdens and potential penalties that it imposes. “Under the best circumstances, practices that are wholly owned or operated by hospitals would face a delay in submitting claims for all Medicare encounters.”

Worse, MGMA contends, practices could face penalties under the False Claims Act if not notified of admissions in a timely manner and attaching the modified coding to claims. “CMS should recognize the unique collaborations that hospitals, group practices and other healthcare providers have formed and avoid setting payment policies that dictate their structure,” the letter states. “We urge CMS to reconsider this policy.” The letter is available here.