Minnesota Hospital Association


November 05, 2018

MHA Newsline: Nov. 5, 2018

In this issue 

MHA selects Kristin Loncorich as vice president, education and member relations

MHA has selected Kristin Loncorich as its new vice president, education and member relations, effective at the end of 2018 upon the retirement of Peggy Westby, vice president, education and membership services.   

Loncorich joined MHA in 2011 as director of state government relations. In addition to working to advance MHA’s policy agenda at the Capitol, she also serves as a staff liaison to the MHA Policy and Advocacy Committee and the Minnesota Hospital PAC Board. Previous staff liaison roles have included the MHA Workforce Development Committee and the Health Care Reform Task Force.  

“Kristin demonstrates exceptional knowledge of and dedication to MHA’s members,” said Lorry Massa, president and CEO, MHA. “Our members and staff have all observed her work ethic and her ability to collaborate to address the significant challenges facing the health care delivery system. Kristin will allow us to not skip a beat in transitioning from Peggy’s tenure with MHA and she will be well-positioned to use her unique expertise to help us build on MHA’s nationally recognized educational and trustee program.” return to top   

MNsure open enrollment runs through Jan. 13, 2019

The 2019 MNsure open enrollment period began Nov. 1 and runs through Jan. 13, 2019. Those who want coverage that begins Jan. 1, 2019, must enroll by Dec. 15, 2018.   

Visit the MNsure website to compare plans from multiple companies and estimate out-of-pocket costs. Current enrollees can check to see if their 2018 plan will be available in 2019.    

MNsure has a statewide network of expert assisters who can help Minnesotans apply and enroll in person, free of cost. In addition, there are enrollment events in communities around the state.  

MNsure’s Contact Center can be reached at 651-539-2099 or 855-366-7873. The center is open Monday through Friday from 8 a.m. to 6 p.m. and Saturday from 10 a.m. to 2 p.m.  

MNsure’s online help tool can be used to check the status of an enrollment or a submitted change, in addition to providing assistance with technical issues and password resets. MNsure’s customer service guide can also be used to find out who to contact with questions and concerns and where to get information on common topics. return to top   

DLI to host workers’ compensation outpatient payment training Nov. 27

The Department of Labor and Industry (DLI) is hosting an in-person training on the hospital outpatient fee schedule (HOFS) and ambulatory surgical center payment system (ASCPS).   

The HOFS and ASCPS are workers’ compensation medical payments provisions adopted by the Legislature in 2018 that went into effect Oct. 1. The training will address reimbursement procedures, billing dispute resolution and the process for submitting medical requests for resolution of disputes. Hospital billing representatives are encouraged to attend.   

The training will be held on Nov. 27 from 9 a.m. to noon in the Minnesota Room at DLI, 443 Lafayette Rd. N., St. Paul, with registration beginning at 8:30 a.m. Sign up for the training on the DLI website.   

Background information, instructions and links to important documents for both the HOFS and ASCPS are available on the DLI website.   

With questions, contact DLI's medical policy staff at 651-284-5052 or via emailreturn to top   

CMS payment rule includes site-neutral payment policies, cuts to 340B payments

The Centers for Medicare and Medicaid Services (CMS) on Nov. 2 released the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule for calendar year (CY) 2019. The rule finalized CMS’ proposal to reduce Medicare payments to excepted off-campus provider-based departments – PBDs billing under the OPPS before Nov. 2, 2015, or meeting the “mid-build” exception as defined in the 21st Century Cures Act.   

Under the rule, Medicare payments for evaluation and management services provided by excepted PBDs would be reduced to 40 percent of the OPPS payment rate. The payment cuts will be phased in over two years, CYs 2019 and 2020. CMS estimates the site-neutral payments will reduce Medicare payments by $380 million in 2019. Additionally, CMS said it will continue to pay non-excepted off-campus PBDs at 40 percent of the OPPS rate. The final rule does not affect clinics on hospital campuses.   

CMS did not finalize the proposal to reduce Medicare payments to expected off-campus PBDs for new “clinical families of services” furnished and billed for after Nov. 2, 2015. However, the agency said it will continue to monitor the expansion of services in excepted off-campus PBDs.   

CMS finalized its proposal reduce payments for 340B-acquired drugs in non-excepted PBDs to average sale price (ASP) minus 22.5 percent. The payment policy aligns with cuts to PPS hospitals called for in the 2018 OPPS rule. CMS estimates the payment change would reduce Medicare payments by $48.5 million in CY 2019. The payment cuts would not apply to critical access hospitals (CAHs), rural sole community hospitals, children’s hospitals or PPS-exempt cancer hospitals. The proposal to reduce Medicare payments for new drugs without ASP data from wholesale acquisition cost (WAC) plus 6 percent to WAC plus 3 percent was also finalized.   

MHA remains opposed to CMS’ site-neutral payment policies and reduced Medicare payments for 340B-acquired drugs.   

With questions, contact Joe Schindler, vice president of finance, MHA, 651-659-1415 or Briana Nord Parish, policy analyst, MHA, 651-603-3498. return to top   

CMS finalizes CY 2019 Physician Fee Schedule rule

The Centers for Medicare and Medicaid Services (CMS) on Nov. 1 issued the Physician Fee Schedule final rule for calendar year (CY) 2019. In the final rule, CMS modified its proposal to collapse payment rates for level two through five evaluation and management services (E/M) into a single rate for new patients and another for established patients.   

In response to public comments, for CY 2019 and CY 2020, CMS will continue the current coding and payment structure for E/M office/outpatient visits. Beginning in 2021, Medicare payment rates for E/M and outpatient visit levels two through four will be consolidated into one payment rate, while the payment rate for level five E/M visits will be maintained order to better account for the care and needs of complex patients   

The final rule seeks to streamline documentation requirements for E/M visits. Beginning Jan. 1, 2019, providers will be required to document only what has changed since the last visit or pertinent items that have not changed, rather than re-documenting information like family/social history. CMS will end the requirement to re-enter information in the medical record regarding a patient’s chief complaint and history if that information was already entered by ancillary staff or the beneficiary.   

Additionally, the final rule removes the restrictions on originating sites for telehealth services treating stroke, kidney disease, mental health and substance abuse.   

The rule finalizes updates to the physician Quality Payment Program for the CY 2019 performance year, which is tied to payment in CY 2021. CMS revamps the Promoting Interoperability performance category of the Merit-based Incentive Payment System (MIPS), aligning it more closely with the Promoting Interoperability program for hospitals, among other modifications.   

As the agency stated in the Outpatient Prospective Payment System (OPPS) final rule, CMS will continue to pay off-campus provider-based departments built after Nov. 2, 2015, at 40 percent of the Medicare outpatient payment rate for services they provide and reduce Medicare payments for new Part B drugs from the rate of wholesale acquisition cost (WAC) plus 6 percent to WAC plus 3 percent.   

With questions, contact Joe Schindler, vice president of finance, MHA, 651-659-1415 or Briana Nord Parish, policy analyst, MHA, 651-603-3498. return to top