ACS Advocacy Brief: September 22

Congressional Champions Introduce Legislation Addressing Medicare Payment Cuts

Surgeons are again facing drastic cuts to Medicare payment at the end of the year due to policies in the Centers for Medicare & Medicaid Services (CMS) calendar year 2023 Medicare Physician Fee Schedule. Last week, Representatives Ami Bera, MD (D-CA), and Larry Bucshon, MD (R-IN), introduced the Supporting Medicare Providers Act of 2022, which would address the nearly 4.5% cut to the Medicare conversion factor beginning in January 2023. The ACS supports this bipartisan legislation, which would provide a critical lifeline to surgeons who are also facing a 4% Pay-As-You-Go (PAYGO) cut.

Unlike other sectors of the healthcare industry, investments in surgeons and other healthcare professionals treating Medicare patients lack an automatic annual update. Medicare payments have failed to keep pace with inflation, including the record, ongoing inflation experienced in 2022, resulting in a real-world decrease year after year. At the same time, the costs of running a medical practice have increased significantly.

Without congressional action, these compounding cuts will jeopardize the financial stability of surgical practices and are, simply put, not sustainable. While the ACS believes that broader reforms are necessary for ensuring long-term stability of the Medicare payment system, the College supports efforts that provide immediate relief to surgical practices facing financial uncertainty.

Take action! Use ACS SurgeonsVoice to write your Representative today, where you can tell them to cosponsor Supporting Medicare Providers Act of 2022 and protect patient access to care.

MIPS Facility-Based Scoring Not Available for 2022 Performance Year

CMS recently finalized the suppression of several measures in the Hospital Value-Based Purchasing (VBP) Program in the fiscal year (FY) 2023 Inpatient Prospective Payment System/Long-Term Care Hospital Prospective Payment System Final Rule. What this means is that CMS will not be able to calculate FY 2023 Hospital VBP Program total performance scores for any hospitals. Since CMS uses the Hospital VBP Program total performance score to calculate Merit-Based Incentive Payment System (MIPS) facility-based scores for the quality and cost performance categories, facility-based clinicians and groups will not receive MIPS facility-based scores for the 2022 performance year.

Facility-based clinicians and groups must collect and submit MIPS quality measures to receive a score other than zero for the quality performance category. Since CMS calculates cost performance category scores using administrative claims, there are no data collection or submission requirements for the cost performance category. However, if the facility-based clinician or group doesn’t meet the case minimum for any cost measures, the cost performance category will be reweighted to 0% and the weight will be redistributed to other performance categories.

Facility-based clinicians and groups without available and applicable measures can request performance category reweighting by submitting a 2022 MIPS Extreme and Uncontrollable Circumstances (EUC) Exception application. Surgeons should cite “COVID-19” as the triggering event.

Additional information can be found on the Quality Payment Program website or in the updated 2022 Facility-Based Quick Start Guide (note – this link initiates a file download).

Submit 2021 MIPS Targeted Review Requests through October 21

Surgeons who participated in MIPS in 2021 can now access their performance feedback by logging in to their accounts on the QPP website. The 2021 MIPS performance feedback reports include MIPS final scores and associated payment adjustments. The 2021 MIPS final scores determine the payment adjustment surgeons will receive in 2023, with a positive, negative, or neutral payment adjustment being applied to the Medicare paid amount for covered professional services furnished in 2023.

Those who believe there are errors in their MIPS performance feedback can submit a request for CMS to review their performance feedback report, final score, or payment adjustment calculations through the Targeted Review process until Friday, October 21. Surgeons can submit a targeted review request through by logging in to their QPP portal with HCQIS Access Roles and Profile System credentials. CMS may request additional documentation supporting the request, but if a targeted review request is approved, CMS could update the final score and/or associated payment adjustments as soon as technically feasible.

More information about the Targeted Review process can be found in the 2021 Targeted Review Guide or on the QPP website. Contact ACS staff at qualityDC@facs.org for more information.

Be Recognized for Your Advocacy

The SurgeonsVoice Advocate of the Year recognition program monitors and recognizes outstanding surgeon advocate participation, including responding to legislative calls to action, utilizing tools and resources, and engaging policymakers in Washington, DC, and at home. Top participants also help cultivate and maintain relationships with legislators, working to advance important ACS-supported advocacy and health policy priorities.

The 2022 Advocate of the Year will be announced at Clinical Congress. The updated list of current top contenders include:

• John H. Armstrong, MD, FACS
• Mark A. Dobbertien, DO, FACS, MBA
• Nancy L. Gantt, MD, FACS
• Marion C. W. Henry, MD, MPH, FACS, FAAP (2021 winner)
• James C. Jeng, MD, FACS
• Krista L. Kaups, MD, MSc, FACS
• William S. Kasper, MD, FACS
• Amy E. Liepert, MD, FACS
• Charles B. Rodning, MD, FACS
• Daniel P. Schaefer, MD, FACS
• Steven Schechter, MD, FACS, FASCRS

There is still time to increase your engagement and be considered for the award. Find ways you can get involved with ACS advocacy, and learn more about your personal advocacy activity by contacting Courtney Eubanks, Grassroots and PAC Coordinator, at ceubanks@facs.org.

Register Now for 2022 On-Demand General Surgery Coding Workshops

To ensure quick prior approvals and more effective appeals, you and your staff need accurate and updated coding information. With on-demand CPT (Current Procedural Terminology) courses, the ACS has the information you need.

The ACS has partnered with KarenZupko & Associates to offer on-demand courses to help you and your coding staff stay on top of changes in CPT coding and documentation. These 60-90 minute on-demand course offerings allow you to learn from anywhere at your own pace.

The courses will help surgeons, practice administrators, managers, coders, and reimbursement staff ensure accurate, consistent, and complete coding.

On-demand courses currently available include:

• Office E/M Coding for Surgeons
• Avoid Denials! Code Hospital Services Correctly!
• Critical Care Coding and Documentation – 2022 Update
• Office Procedures – Document and Code Them Right

Each course is accredited for AMA PRA Category 1 Credits™, and discounts are available for team members or practice employees of ACS members.

Don’t give health plans a reason to decline payment. Using old codes, being unaware of the recent rule changes on split/shared visit billing, and misusing critical care coding and billing are all expensive mistakes.

For more information or questions about the 2022 ACS live coding workshops and on-demand courses, visit the KZA website or contact practicemanagement@facs.org.