After a recent brief shutdown of the federal government, the Congress passed and the President signed into a law the Bipartisan Budget Act of 2018. The vote of the senate was 71-28 and the House vote stood at 240-186 to approve this legislation.
According to this legislation it provides for a two-year budget agreement that surges the budget caps, resulting in roughly a $300 billion in additional federal spending. The regulation increases both defense and domestic spending, appends the federal debt ceiling until March 2019, and also includes funds for hurricane and wildfire disaster relief, among other programs.
The legislation extends stopgap funding through March 23, 2018 to let the federal government fully operating and to give Congress time to enact a full-year omnibus appropriations measure for Fiscal Year 2018 (FY18).
The new law further extends and modifies dozens of health care programs, comprising of fund extension for two years for community health centers and extending the CHIP (Children's Health Insurance Program) for an additional four years through FY27.
Similar to the House-passed Continuing Resolution (CR), the bill provides funding for a number of Medicare extenders and integrates policy reforms from the CHRONIC Care Act and the Medicare Part B Improvement Act, which impacts Stark Law compliance, physician payment plans, tele-health, home health services, and also medical billing and coding for claims reimbursements.
Further, bipartisan legislation includes the funding of National Institutes of Health (NIH) and for efforts to combat the opioid crisis. Lastly, the legislation abolishes the Affordable Care Act's (ACA) Independent Payment Advisory Board (IPAB) and eliminates the Medicaid Disproportionate Share Hospital (DSH) reductions scheduled for FY18 and FY19.
A vital point to remember here is that the legislation does not include ACA market stabilization measures to address ongoing ambiguity and turmoil in the personal insurance market.
However, buried under the 600-plus page federal spending regulation, policymakers also included provisions that would impact claims reimbursement for health care providers. The deal will impact the Affordable Care Act’s Independent Payment Advisory Board, the Merit-Based Incentive Payment System (MIPS) Medicaid Disproportionate Share Hospital payments and Medicare Physician Fee Schedule payment updates.
The Bipartisan Budget Act of 2018 abolished the Independent Payment Advisory Board (IPAB), a board created under the Affordable Care Act to keep Medicare spending under control.
The board as originally drafted was supposed to include 15 experts appointed by the President and three HHS officials. The esteemed panel then would convene if Medicare spending was slated to exceed specific growth rate targets mentioned in the Affordable Care Act.
With the legislation - Congress delayed cuts to Medicaid Disproportionate Share Hospital (DSH) payments for another two years under the new budget law. Earlier, hospitals received Medicaid DSH payments for handling a greater portion of low-income, vulnerable patients.
While these payments help to support safety-net hospitals and uncompensated care costs, the Affordable Care Act mandated that CMS reduce Medicaid DSH payments starting in 2014 as hospitals see coverage gains under Medicaid expansion programs.
In lieu of extending the miss-valued code provision detailed in the new legislation, the Bipartisan Budget Act of 2018 will actually decrease the Medicare Physician Fee Schedule (PFS) conversion from 0.5 percent to 0.25 percent in the upcoming year of 2019.
The miss-valued code policy from 2014 which is “set targets to reduce Medicare spending on so-called miss-valued or overvalued codes, and then reduces payments in the Medicare fee schedule if the targets are not met,” the AMA explained.
The newly proposed budget deals included one and two-year extensions of the policy. However, provider administrations, like the AMA, argued that the miss-valued code policy was no longer necessary. The AMA later explained that there were little to no miss-valued services left to review and revalue.
All in all a dent to the pocket of the physicians in the form claims reimbursement will be there. It will depend on your medical billing team also as to how they view this transition and code accordingly.