MACRA Memo for the HBMA Membership

The following is a brief summary of some of the key components of the new Medicare Incentive Payment System/Alternative Payment Model program that will begin taking effect on January 1, 2017.  On November 14th, HBMA Director of Government Affairs, Bill Finerfrock, will be doing a kick-off webinar highlighting some of the key components of the new MIPS program.  Please visit the HBMA website for instructions on how to sign up for this and future webinars.


Over the next several months, HBMA will be delivering MIPS/APM information to the membership in a variety of formats – articles, webinars, meetings – to help you prepare for MIPS and identify what you and your clients need to know in order to be successful under this new payment system.  If there are MIPS topics or subjects you would like HBMA to offer education, please do not hesitate to contact the HBMA Education Committee with your suggestions.


See the full document here

HBMA CMS/Hill Day Publication Now Available

This June, the Healthcare Business Management Association (HBMA) celebrated ten years of advocacy at Centers for Medicare & Medicaid Services (CMS) on Capitol Hill and with strategic industry partners.
Representatives from HBMA’s Leadership and Government Relations (GR) Committee met face-to-face with senior CMS management and discussed a variety of operational and policy issues of interest to both CMS and the HBMA membership. This outreach effort is initiated by HBMA because of the membership’s strong desire to have a Medicare program that operates efficiently and smoothly to the benefit of patients, providers, and taxpayers.

Please click here to view the June 2016 HBMA CMS/Hill Day Visit Publication.

HBMA members are able to identify policy implementation options for CMS that result in far smaller administrative burdens for RCM billing companies and their clients than would have occurred had CMS implemented their original plan.   Engaging in this type of dialogue reaps both near-term and long-term benefits for HBMA membership. In the near-term, we are able to bring issues and topics to the attention of the senior leadership of the Medicare program and effectively by-pass the lower levels of the bureaucracy where issues and problems often get lost. In the long-term, it is an ongoing, consistent annual reminder of the expertise, knowledge, and collective experience of the HBMA membership. Our substantial footprint in claims filing (over 30% of all physician claims) and our willingness to be a resource and valued trading partner to ensure that Medicare claims get processed efficiently and accurately.   If you have any questions about this initiative, its purpose or value, please contact Bill Finerfrock, HBMA Director of Government Relations or Andre Williams, HBMA Executive Director.

Access Past Publications Here:

View the 2015 CMS/Hill Day Publication

View the 2014 CMS/Hill Day Publication

HBMA Comments on MPFS

On behalf of the Healthcare Business Management Association (HBMA) we are pleased to submit these comments on the 2017 Medicare Physician Fee Schedule Proposed Rule.

HBMA is a non-profit trade association of companies providing medical billing and related services to physicians, hospitals, non-physicians (ambulance, DME, ASC, IDTF, Rural Health Clinics, FQHCs, etc.) and other health care organizations throughout the United States. For nearly twenty years, HBMA has been the recognized billing industry organization for education, advocacy and cooperation in all matters that affect the processing of provider claim-related data, compliance and management services. It is estimated that our member companies process in excess of 350 million claims annually and serve virtually every clinical specialty, in every setting, in every state.

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MLN – Physician Fee Schedule & Outpatient PPS Proposed Rules Released

Physician Fee Schedule: Proposed CY 2017 Changes

Medicare also expands the Diabetes Prevention Program

On July 7, CMS proposed changes to the Physician Fee Schedule to transform how Medicare pays for primary care through a new focus on care management and behavioral health designed to recognize the importance of the primary care work physicians perform. The rule also proposes policies to expand the Diabetes Prevention Program within Medicare starting January 1, 2018.

The annual Physician Fee Schedule updates payment policies, payment rates, and quality provisions for services provided in calendar year 2017. These services include, but are not limited to visits, surgical procedures, diagnostic tests, therapy services, and specified preventive services. In addition to physicians, the fee schedule pays a variety of practitioners and entities, including nurse practitioners, physician assistants, physical therapists, as well as radiation therapy centers and independent diagnostic testing facilities. Additional policies proposed in the 2017 payment rule include:

  • Primary care and care coordination
  • Mental and behavioral health
  • Cognitive impairment care assessment and planning
  • Care for patients with mobility-related impairments

For More Information:

See the full text of this excerpted CMS press release (issued July 7).

Hospital and ASC: Proposed OPPS Changes for CY 2017

On July 6, CMS proposed updated payment rates and policy changes in the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System. Several of the proposed policy changes would improve the quality of care Medicare patients receive by better supporting their physicians and other health care providers. These proposals are based on feedback from stakeholders, including beneficiary and patient advocates, as well as health care providers, including hospitals, ambulatory surgical centers and the physician community.

Proposed changes include:

  • Addressing physicians’ concerns regarding pain management
  • Focusing payments on patients rather than setting
  • Improving patient care through technology
  • Emphasizing health outcomes that matter to the patient

CMS estimates that the updates in the proposed rule would increase OPPS payments by 1.6 percent and ASC payments by 1.2 percent in 2017.

For More Information:

See the full text of this excerpted CMS press release (issued July 6).

HBMA Comments on MIPS

On behalf of the Healthcare Business Management Association (HBMA), we appreciate the opportunity to provide observations and comments about the proposed rules for the Merit-based Incentive Payment System (MIPS) and the requirements for approval as an Advanced Alternative Payment Model as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

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