6 Key Takeaways for Providers on BPCI-Advanced (Value-Based Medicare Payment)

Despite some initial difficulty in gaining momentum, the use of value-based payment methodologies will likely increase across all provider niches. This change is partly a function of cost savings driven by margin compression (e.g. inpatient care) as well as by government payment models rewarding quality and efficiency, such as the Medicare Access and CHIP Reauthorization Act (MACRA).  Recent comments by Health and Human Services Secretary Azar suggest he finds that the results of the tested voluntary alternative payment models have been underwhelming and he may be ready for bolder payment programs to reform Medicare payments, including more mandatory programs.  As the newest kid on the block of value-based payment programs, the Bundled Payment For Care  Improvement–Advanced (BPCI-A)  should be carefully assessed  by and engaged in by providers for several reasons. We list six of these here.

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California Medicaid Agency Proposes Significant Restrictions on FQHC and RHC Reimbursement


California’s Medicaid agency has posted draft language of a new state plan amendment (SPA) that would make major changes to federally qualified health center (FQHC) and Rural Health Clinic (RHC) reimbursement.  Public comments may be made on the proposal until 5 PM on March 23, 2018.  Following review of public comments, the California Department of Health Care Services (DHCS) may make revisions to the SPA before submitting it to the federal Centers for Medicare and Medicaid Services (CMS) for approval.  If approved, the SPA would be retroactive to January 1, 2018.

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Telehealth Billing Compliance: Medicare Says Goodbye to the GT Modifier


For over a decade, Medicare has required providers to append special modifiers to their CPT and HCPCS codes when billing for telehealth services. The two primary modifiers for telehealth services were GT (indicating the service was delivered via an interactive audio and video telecommunications system) and GQ (indicating the service was delivered via an asynchronous telecommunications system). Effective January 1, 2018 that has changed because CMS has decided to largely eliminate the requirement to use the GT modifier on telehealth claims.

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Congress Proposes Change to Ryan Haight Act to Allow Telemedicine Prescribing of Controlled Substances

controlled substances

It seems the efforts of telemedicine advocates to change federal law and allow greater prescribing of controlled substances are no longer falling on deaf ears. Congress just released a pair of draft discussion bills to amend the federal Ryan Haight Act.

The “Improving Access to Remote Behavioral Health Treatment Act” would allow certain community mental health centers and addiction treatment centers to obtain DEA registration as a clinic, thereby allowing telemedicine providers to prescribe controlled substances to patients present at those sites without the need for an in-person examination. Currently, treatment  sites are restricted to DEA-registered hospitals and some very limited other non-hospital clinics. POLITICO Pro Morning eHealth reporter, Mohana Ravindranath, was among the first to report on the new legislation.

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NLRB: Changing Winds Blow in Favor of Health Care Employers

hospital staff

The Trump administration’s mark is certainly evident at the National Labor Relations Board (NLRB) and health care employers are breathing a sigh of relief.

The NLRB is a five member Board that decides cases governing most aspects of private sector labor relations in the health care industry.  The manner in which Board members’ terms are staggered allows a sitting President to eventually place three of the five members from his own political party. In fact, President Trump recently appointed two new Republican members, which, for the first time in almost seven years, created a Republican majority.

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