Federal Legislative Update
ACR-Led Coalition Continues to Work with Congress to Address Medicare Payment Cuts
The Centers for Medicare & Medicaid Services (CMS) finalized a 3.4% cut in Medicare physician payment in the Calendar Year 2024 Medicare Physician Fee Schedule (MPFS) final rule issued November 2. These cuts are a result of efforts to increase payments for primary care due to the finalization of the new G2211 code.
Following the release of the final rule, ACR led a coalition of physicians and non-physician groups in a communication to congressional leadership, urging Congress to stop the full 3.4% cut. Shortly after, the U.S. Senate Committee on Finance released and voted in favor of draft legislation, the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act, which included a 1.25% increase to the 2024 Medicare physician payment conversion factor (CF). This is one of several Congressional proposals being considered aimed at reforming Medicare payment.
Earlier this year, Reps. Raul Ruiz, MD (D-CA), Larry Bucshon, MD (R-IN), Ami Bera, MD (D-CA), and Mariannette Miller-Meeks, MD (R-IA), introduced H.R. 2474, the Strengthening Medicare for Patients and Providers Act. Supported by ACR, the legislation would add a permanent, MEI-based inflationary update to the MPFS.
Another proposal put forward by the GOP Doctors Caucus Co-Chairs, Reps. Greg Murphy (R-NC), Brad Wenstrup, and Michael Burgess (R-TX), working closely with Ways and Means Committee Chairman Jason Smith (R-MO), is being considered by U.S. House of Representatives Energy and Commerce Subcommittee on Health. The bill, H.R. 6371, or the Provider Reimbursement Stability Act of 2023, seeks to reform the budget neutrality policies applied to the MPFS by assuring that CMS payment policy is based on reality, not projections. While this is a key component of Medicare physician payment reform, it is important for medicine to continue pressing for other areas of reform, including (1) automatic, annual inflation updates based on the Medicare Economic Index (MEI) as proposed by H.R. 2474, (2) reduces administrative burden and improves the clinical relevance of the Merit-based Incentive Payment System (MIPS); and (3) maintains a viable pathway for physicians to opt into alternative payment models.
ACR appreciates the various proposals being considered to address Medicare payment cuts and will continue to work through the rest of the year with its provider colleagues to stop the full 3.4 % cut before Congress adjourns.
For more information about ACR’s actions to fight Medicare reimbursement cuts, please contact
Rebecca Spangler, ACR Senior Government Affairs Director.
No Surprises Act Legal Update
Legal Update
There have been several court decisions challenging the implementation of the No Surprises Act (NSA) in favor of the medical community. ACR has joined lawsuits by the Texas Medical Association (TMA) as a friend of the court, with the American Society of Anesthesiologists (ASA) and American College of Emergency Physicians (ACEP).
Most recently, a decision for “TMA IV” was issued on August 3 and the court held that the independent dispute resolution (IDR) administrative fee increase and batching rules violated federal law. Shortly after, CMS announced the repeal of the 600% IDR administrative fee increase, and the $350 fee was reduced back down to $50. Later that month, the court issued a ruling on “TMA III”, stating that the government was incorrectly permitting insurers to use a faulty methodology when calculating their median in-network rate, also known as the qualifying payment amount (QPA). This overturned several regulatory provisions, including those that enabled insurers to include in the calculation of QPAs contracted rates for services that physicians do not provide, known as “ghost rates.” The government intends to appeal.
Previously, the court also held against the federal government regarding the Qualifying Payment Amount (QPA), stating those regulations unlawfully placed a “thumb on the scale” for the QPA over other factors arbitrators must consider. While the federal government has appealed this decision and ACR, ASA and ACEP have filed a brief in response, the outcome is still pending.
New Guidance Proposals
In September, HHS issued a proposed rule, outlining a new fee structure for the IDR process. The proposed new administrative fee, which is required to be paid by both providers and payers entering the IDR process, is $150 beginning January 1, 2024. This triples the $50 fee which CMS reverted to following the TMA IV court decision and is still not workable for radiologists. The proposed fees for batches have also increased and the larger the batch, the higher the fee. ACR has submitted comments on the proposal rule and awaits the final rule.
In October, another proposed rule was released outlining rules related to the “operations” of the federal IDR process. ACR is encouraged that they have listened to some of our concerns. Specifically, the proposed rule would: provide expanded batching regulations, reduce the administrative fee for low-dollar claim disputes, and require insurers to provide claim eligibility information with initial payments (effective January 2025). However, ACR still has issue with some details within the proposed rule, including limiting batching to 25 line items in a single dispute. The College will be submitting comments to the agencies.
For more information, please contact
Ashley Walton, ACR Government Affairs Director.
ACR Urges Congress to Address Physician Payment Cuts Associated with Clinical Labor Policy
The American College of Radiology® (ACR®) and other national medical societies have been working with Congress to address payment cuts associated with a Centers for Medicare and Medicaid Services (CMS) clinical labor pricing update. This policy was finalized in the Calendar Year 2022 Medicare Physician Fee Schedule (MPFS) rule to update clinical labor pricing over a four-year period starting in 2022.
Clinical labor staff, medical supplies, and equipment costs are three components of direct practice expense (PE) inputs, which are costs directly associated with the provision of a service or procedure. They are budget neutral, which means that an increase in payment for one component typically means a proportional decrease in payment for the other components. The updated clinical labor policy has resulted in significant code level reduction for codes with high medical supplies and equipment costs, including some interventional radiology and radiation oncology codes.
Leading up to an October 19th U.S. House of Representatives Energy and Commerce Subcommittee on Health hearing, “What’s the Prognosis? Examining Medicare Proposals to Improve Patient Access to Care & Minimize Red Tape for Doctors," ACR joined other medical societies in a communication to the Hill supporting H.R. 3674, the Providing Relief and Stability for Medicare Patients Act of 2023. Supported by ACR and the Clinical Labor Coalition (CLC), the legislation addresses the needs of specialty physicians practicing in community-based office settings that have been disproportionately impacted by CMS’ clinical labor update policy. Introduced by Reps. Bilirakis (R-FL), Cardenas (D-CA), Murphy (R-NC), and Davis (D-IL), H.R. 3674 would provide critical relief for office-based specialists by increasing the non-facility/office-based practice expense relative value units negatively impacted by CMS’ clinical labor policy for the next two years.
ACR appreciates the subcommittee’s efforts to highlight H.R. 3674 in the recent hearing and issued a statement (link) with the CLC commending its inclusion in policy discussions aimed at mitigating forthcoming Medicare reimbursement cuts. The College will continue to work with Congress to address payment cuts associated with clinical labor.
For more information, please contact
Ashley Walton, ACR Government Affairs Director.
