APMA News - January/February 2020 - 26

W

CAC-PIAC Meeting: What to Know
About Reimbursement in 2020

hen you run into a local reimbursement problem, where do you turn first? As an APMA member, your answer should be your Carrier Advisory
Committee (CAC) or Private Insurance Advisory Committee
(PIAC) representative. These individuals are your state experts
for dealing with reimbursement issues with both public and
private payers.
Once a year, these individuals meet to hear from experts
and discuss the common problems they face. The 19th Annual
CAC-PIAC Meeting took place Friday, November 15, in Alexandria, VA. The meeting set the stage for what physicians can
expect in 2020, with speakers touching on everything from
LCD development and CERT errors to the 2020 CY Medicare
Physician Fee Schedule (MPFS) and Medicare Advantage (MA)
plan coverage policies.
Attendees heard from Rochelle Fink, MD, JD, CMS-FDA
Liaison with the CMS Coverage and Analysis Group. Dr. Fink
covered updates to Medicare's LCD development process. Attendees expressed their concerns with the lack of provider
involvement in the new LCD development process and the

2020 MPFS: Four Important Takeaways
Final 2019 Conversion Factor is +0.14 percent
* over
2019
Podiatrists should see a 2-percent increase in
* reimbursement
under Original Medicare Fee
For Service

Effective January 1, 2021, E/M documentation
* changes
will allow for more flexibility in documenting
E/M services-physicians will be able to choose
between medical decision making, time

Effective January 1, 2021, levels 2 through 4 E/M
* codes
for new and established patients will be
consolidated, but level 5 will remain separate

impact on coverage for Medicare beneficiaries. They also heard
from Bekah Nelson and Patrick Peick, CPO, from Noridian
Healthcare Solutions. Nelson addressed common CERT errors,
among other topics.
Cindy Moon, MPP, MPH, vice president at Hart Health Strategies and APMA consultant, provided a Medicare policy update
including updates to the 2020 CY MPFS and MIPS participation
in 2020. Kelli Back, Esq., APMA's long-standing private insurance consultant, provided an update on trends in the private
insurance world, including MA issues. She addressed the recent
concern regarding the uptick in recoupments pursued by MA
organizations and providers' rights in addressing those recoupments. She also reviewed network adequacy rules, how to deal
with onerous record requests, and new non-traditional benefits
available under some supplemental plans for beneficiaries with
serious chronic illnesses such as diabetes.
An important part of any CAC-PIAC meeting is the chance
for attendees to talk about what is happening in their state and
see if other states are experiencing similar issues. Participants
had robust discussions about current concerns with both public and private payers, including MA plans' coverage policies,
MA chart reviews, private payer new and updated -25 modifier policies, and Same or Similar denials by DME MACs.
New this year, awards were given to two representatives
to recognize their significant contribution to the profession by
ensuring equitable coverage of services by podiatrists. Paul
Kinberg, DPM, CAC representative from the Texas Podiatric
Medical Association, was honored as the CAC-PIAC Representative of the Year. Additionally, Jodie Sengstock, DPM, CAC
representative for the Michigan Podiatric Medical Association,
was recognized with the Rising Star Award.
If you haven't heard from your local CAC and PIAC representatives about the meeting, expect to soon. More information, including a list of representatives, is available at www.
apma.org/cacpiac.
n

MIPS 2020: What You Need to Know
maintains the same policies from 2019
* toLargely
2020 (low volume threshold, performance category
weights, and reporting options remain the same)

Performance threshold to avoid a penalty will be
* 45
points now, instead of 30 points (2019)
CMS
contemplating switching from individual
* performance
categories to unified framework-
MIPS Value Pathway Measures (MVPs)

Your 2019 CAC and PIAC representatives.

26 APMA News January/February 2020
http://www.apma.org/cacpiac
APMA News - January/February 2020

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