A Discussion with Jeff Davis, Director at McDermott+ on the PFS final rule! youtu.be/oP40ZQad70Y?si=5sJt… via @YouTube

As discussed in this @InHealthPolicy article, the federal regulatory machine is still moving during the shutdown. While the major Medicare payment rules could be delayed, they could wind up being released on time on November 1 since they are statutorily required! Also, the Inside Health Policy article discusses the last two Regs & Eggs blog posts: one related to the shutdown co-authored by Erin Fuller and the other related to Medicare spending coauthored by Parashar Patel. With respect to the Medicare spending regs and eggs blog post: “McDermott+ analyzed the proposed PFS and hospital outpatient pay rules in a recent blog and determined policymakers should look for other ways to control costs in Medicare fee-for-service. “Rising Medicare spending may continue to put pressure on policymakers, including Congress and CMS, to develop cost-cutting approaches, despite the fact that Medicare payment rates have already been squeezed,” the McDermott+ Regs & Eggs post says. “Medicare actuaries project that Medicare payment rates will not drive future growth in Medicare spending.”” Read the shutdown regs and eggs blog post: mcdermottplus.com/blog/regs-… Read the Medicare spending regs and eggs blog post: mcdermottplus.com/blog/regs-…

Great talking to Cara Smith at Inside Health Policy about the expiration of the telehealth flexibilities and the impact that is having on providers and patients. “Jeff Davis, the author of McDermott+’s regulatory affairs blog, said CMS’ guidance issued yesterday (Sept. 29) highlighted that holding claims during the shutdown should not face immediate disruption from the usual claim process unless the shutdown continues for more than two weeks. CMS also recommended in the memo that telehealth providers offer an advanced beneficiary notice ahead of a telehealth appointment during the shutdown, which disturbs the traditional workflow of issuing a beneficiary notice after an appointment. If Congress doesn’t act to extend telehealth flexibilities and include retroactive reimbursement, beneficiaries would be responsible for the entire cost of the appointment that occurs during the shutdown. Davis said the agency is making this recommendation because this is the first time in five years these services are not covered by Medicare. “They're letting beneficiaries know that if they're going to provide a telehealth service and one of the restricted ones is no longer covered under Medicare, then it may not be a covered service,” Davis said. “They're banking on the fact that Congress is eventually going to retroactively restore these services.” A physician told IHP that it would be helpful if HHS’ Office of Inspector General or the Department of Justice issued a non-enforcement letter about Medicare inducement penalties, which penalize providers who provide free medical services to beneficiaries. Davis said it is unlikely that the Trump administration would issue another letter. “It's not a covered service under Medicare, so CMS and HHS’ hands are pretty much tied,” he said. “What can they do? It's totally in Congress's court.”