Myths and Facts about H.R. 2

The American Medical Association, the Massachusetts Medical Society, and over 750 national and state-based physician and specialty organizations have gone on record in support of H.R. 2, the “Medicare Access and CHIP Reauthorization Act.” 

Myth: H.R. 2 mandates physician participation in Maintenance of Certification (MOC).

False. Nothing in H.R. 2 mandates maintenance of certification, nor does it penalize physicians for not participating in MOC.

Myth: H.R. 2 requires MIPS quality standards to be based only on input from certification boards, such as the American Board of Internal Medicine (ABIM) or the American Board of Medical Specialties (ABMS).

False. Professional organizations defined by certification boards are only one of many stakeholders— including other physicians and physician groups—that can provide input on quality measures under the MIPS program. Under H.R. 2, the existing PQRS, MU, and VBM programs are streamlined into the MIPS program. Many of the MIPS quality measures will be based upon existing measures that are still considered valid and are currently used for PQRS, MU, VBM, and qualified clinical data registries. The bill would require the Secretary of Health and Human Services (HHS) to get input from a wide variety of stakeholders on the selection of quality measures, including “relevant eligible professional organizations and other relevant stakeholders, including State and national medical societies.”

Furthermore, H.R. 2 lists “clinical or surgical checklists and practice assessments related to maintaining certification” (not the maintenance of certification itself) as just one of the examples of the type of clinical practice improvement activities for the required category of “patient safety and practice assessment” activities. However, there are five other categories to choose from, and the Secretary can add more categories, in consultation with “stakeholders.”

Myth: H.R. 2 would eliminate fee-for-service completely.

False. Under H.R. 2, fee-for-service remains the basic, fundamental payment system for Medicare Part B services under the Physician Fee Schedule. H.R. 2 includes incentives and support for physicians to participate in new payment and delivery models, including $20 million per year (from 2016-2020) in technical assistance funds for small practices to transition to new payment models or participate in the MIPS. But participation in these models is completely optional.

Myth: H.R. 2 sets a new requirement that the quality of physicians’ care must be compared with the quality of care by non-physicians.

False. PQRS currently does not differentiate in its assessment of physicians and non-physicians, although all eligible professionals (EPs) are allowed to select their own quality measures. The same will be true for the MIPS program. The MIPS requirements will apply to a wide array of non-physicians— dentists, podiatrists, optometrists, chiropractors, physician assistants, nurse practitioners, clinical nurse specialists, and nurse anesthetists—who are not currently subject to MU and VBM requirements. 

Both physician and non-physician EPs will be assessed against the same MIPS “performance threshold.”

Myth: Section 507 of H.R. 2 allows the Secretary of Health and Human Services to punish physicians who opt out of Medicare.

False. The Secretary of HHS cannot selectively punish a physician because of his/her opt-out status.

Myth: Section 507 of H.R. 2 bans physicians who opt out of Medicare from writing prescriptions under the Part D program.

False. Under current regulations, physicians who opt out of the Medicare program can still write prescriptions under the Medicare Part D program for covered beneficiaries, assuming they have filed an opt-out affidavit as required under existing law. In general, most practicing physicians are required to have a valid National Provider Identifier (NPI)—a requirement that is not limited to those who participate in the Medicare program, but includes those who opt out as well.

The purpose of the NPI is to uniquely identify a health care provider in standard transactions, such as health care claims. NPIs may also be used to identify health care providers on prescriptions, in coordination of benefits between health plans, in patient medical record systems, in program integrity files, and in other ways. The Health Insurance Portability and Accountability Act (HIPAA) requires that covered entities, including physicians, use NPIs in standard transactions. There has been an ongoing concern that the NPIs placed on Part D pharmacy claims have included invalid NPI claims—these could include NPIs that do not actually correspond to the prescriber, are expired NPIs, or are NPIs for deceased physicians, for example. Section 507 is designed to ensure that NPIs are correct to prevent fraudulent use of an NPI in the case of identity theft or where a prescriber’s other identification (DEA number, for example) does not correspond to the NPI.

Myth: H.R. 2 creates new authority for the government to place a levy on Medicare payments if providers are delinquent on their taxes.

False. The Federal Payment Levy Program (FPLP) was first authorized under the Taxpayer Relief Act of 1997. This law allows the government to collect overdue taxes through a levy on certain federal payments (e.g., federal employee retirement annuities, contractors/vendors doing business with the government, certain Social Security benefits), including Medicare provider and supplier payments. The Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 expanded the FPLP to include a levy against Medicare payments for non-tax debt. Under MIPPA, CMS could have reduced federal payments subject to the levy by 15 percent until the overdue taxes were paid in full, and could have reduced federal payments subject to a non-tax levy by 100 percent or the amount of the non-tax debt owed. The Tax Increase Prevention Act of 2014 made further amendments to increase the levy rate from 15 percent to 30 percent on payments due to a Medicare provider or supplier for overdue taxes. H.R. 2 would increase the existing levy rate from 30 percent to 100 percent.

-- From the American Medical Association

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