APMA News - January/February 2024 - 27
program. This last finalized proposal was a major
victory for members, and something APMA spent
several years advocating.
Particular emphasis was placed on the MIPS program.
Based on a pre-meeting survey, the majority
of respondents are unprepared for the renewed
focus on the program in 2024 and the increased
threshold to avoid penalties. Find resources to
bring your office up to speed at www.apma.
org/mips2024 and keep your full 2026 Medicare
reimbursements.
APMA private insurance consultant Kelli Back,
Esq., provided attendees an update on ongoing
issues and trends for Medicare Advantage (MA)
and commercial plans. She noted MA organizations
may only require prior authorization for
very specific and defined purposes. Under a new
rule, a decision to deny a prior authorization or
pre-determination request must be reviewed by a
physician or other appropriate health-care professional
with a current and unrestricted US license
and " expertise in the field of medicine or health
care that is appropriate for the services at issue. "
Additionally, to ensure prior authorization policies
and utilization management procedures are
consistent with applicable requirements, the new
rules require MA organizations to have a utilization
management committee.
An essential aspect of the CAC-PIAC meeting
is the open forum allowing attendees to discuss
issues in their jurisdiction. In the public insurance
arena, the biggest areas of concern are the continued
DME same and similar denials, coverage for
wound care, and amniotic injections/skin substitutes.
For private payers, topics noted included
bundling and reimbursement issues for Medicare
Advantage versus Original Medicare, denials or
reimbursement reduction for claims billed with the
-59 or -25 modifiers, DME audits, prior authorizations,
and record requests.
During the meeting, Brent Harwood, DPM, was
honored with the Franklin Kase, DPM, CAC-PIAC
Representative of the Year award. Dr. Harwood has
served in his role as CAC and PIAC representative
for Alabama for more than 20 years. In addition
to his decades of service fighting reimbursement
battles, he was instrumental in the recent victory
modernizing the Alabama scope of practice
to include ankle privileges. Additionally, Theresa
Hughes, DPM, was elected to serve another term
as CAC chair.
If you are experiencing challenges with payers,
reach out to your CAC and PIAC representatives
for guidance. Resources are available at www.
apma.org/cacpiac. For additional questions, contact
healthpolicy.hpp@apma.org.
APMA.ORG
apmanews
27
http://www.apma.org/mips2024
http://www.apma.org/mips2024
http://www.apma.org/cacpiac
http://www.apma.org/cacpiac
http://www.APMA.ORG
APMA News - January/February 2024
Table of Contents for the Digital Edition of APMA News - January/February 2024
Contents
APMA News - January/February 2024 - Cover1
APMA News - January/February 2024 - Cover2
APMA News - January/February 2024 - 3
APMA News - January/February 2024 - 4
APMA News - January/February 2024 - 5
APMA News - January/February 2024 - 6
APMA News - January/February 2024 - 7
APMA News - January/February 2024 - 8
APMA News - January/February 2024 - Contents
APMA News - January/February 2024 - 10
APMA News - January/February 2024 - 11
APMA News - January/February 2024 - 12
APMA News - January/February 2024 - 13
APMA News - January/February 2024 - 14
APMA News - January/February 2024 - 15
APMA News - January/February 2024 - 16
APMA News - January/February 2024 - 17
APMA News - January/February 2024 - 18
APMA News - January/February 2024 - 19
APMA News - January/February 2024 - 20
APMA News - January/February 2024 - 21
APMA News - January/February 2024 - 22
APMA News - January/February 2024 - 23
APMA News - January/February 2024 - 24
APMA News - January/February 2024 - 25
APMA News - January/February 2024 - 26
APMA News - January/February 2024 - 27
APMA News - January/February 2024 - 28
APMA News - January/February 2024 - 29
APMA News - January/February 2024 - 30
APMA News - January/February 2024 - 31
APMA News - January/February 2024 - 32
APMA News - January/February 2024 - 33
APMA News - January/February 2024 - 34
APMA News - January/February 2024 - 35
APMA News - January/February 2024 - 36
APMA News - January/February 2024 - 37
APMA News - January/February 2024 - 38
APMA News - January/February 2024 - 39
APMA News - January/February 2024 - 40
APMA News - January/February 2024 - 41
APMA News - January/February 2024 - 42
APMA News - January/February 2024 - 43
APMA News - January/February 2024 - 44
APMA News - January/February 2024 - 45
APMA News - January/February 2024 - 46
APMA News - January/February 2024 - 47
APMA News - January/February 2024 - 48
APMA News - January/February 2024 - 49
APMA News - January/February 2024 - 50
APMA News - January/February 2024 - 51
APMA News - January/February 2024 - 52
APMA News - January/February 2024 - 53
APMA News - January/February 2024 - 54
APMA News - January/February 2024 - 55
APMA News - January/February 2024 - 56
APMA News - January/February 2024 - 57
APMA News - January/February 2024 - 58
APMA News - January/February 2024 - 59
APMA News - January/February 2024 - 60
APMA News - January/February 2024 - 61
APMA News - January/February 2024 - 62
APMA News - January/February 2024 - Cover3
APMA News - January/February 2024 - Cover4
APMA News - January/February 2024 - A1
APMA News - January/February 2024 - A2
APMA News - January/February 2024 - A3
APMA News - January/February 2024 - A4
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