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In One, Out the Other

August 11, 2014

by Mike Amery, Esq, AAN Legislative Counsel 

Medicaid Bump Legislation
We knew it was coming. We just didn’t know that it would come twice in the same week.

Just before leaving for the summer recess, legislation to extend the Medicaid bump was introduced in both the House and the Senate. The Medicaid bump, which provides Medicaid providers with Medicare rates, is one of the provisions in the Affordable Care Act that benefits primary care providers (and many others) but has the unintended consequences of omitting cognitive physicians like neurologists who bill the exact same codes as PCPs.

The Medicaid bump expires at the end of this year so we knew that legislation would be in the works by supporters to get it extended.

House Victory
In a big victory for the AAN, the lead Democrats on the House Energy and Commerce Committee, Henry Waxman (D-CA) and Frank Pallone (D-NJ) filed a bill to extend the Children’s Health Insurance Program, including a provision to add neurology to an extension of the Medicaid bump through 2019.

We are very appreciative of both Congressmen Waxman and Pallone, but also of their staff who have heard not only from the AAN DC lobbying team, but also from so many members of Congress who were reached by AAN advocates through Neurology on the Hill and grassroots lobbying.

Work to Do in the Senate
The good news in the House came right after bad news from the Senate.

Sens. Sharrod Brown (D-OH) and Patty Murray (D-WA) introduced a bill that would extend the bump for two years and add OB/Gyns, but not neurology.

The AAN had been to Sen. Brown’s office several times, but with the constant staff changes in Capitol Hill offices we had never met with the lead staff for the bill. I went in immediately to describe the unfairness of this provision to patients with neurological conditions. I was told, “It is a work in progress and we are taking comments,” so they are certainly aware of our concerns now and we plan to participate fully in the debate.

Bump Prospects
Both of these bills were introduced without Republican cosponsors and I have yet to talk with a Republican who is interested in extending the Medicaid bump. First, the provision is really expensive; an estimated $5 billion for one year. Second, as it is a part of “Obamacare” Republicans have no problem simply letting it expire.

But the point of the AAN’s efforts is that there is a crisis in the physician community, not just for primary care, but for everyone who primarily bills evaluation and management codes.

We will continue to work to add neurology to any effort that extends the Medicaid bump or any other primary care bonuses. We will let you know when to contact your members of Congress on this important issue. For those of you in Ohio and Washington, please be on the lookout soon.


Regulatory Corner
by Daneen Grooms, AAN Regulatory Affairs Manager

Recent OIG Report Examines Billing of Electrodiagnostic Tests; AAN Reviewing Methodology
The Office of Inspector General (OIG) is a part of the Department of Health and Human Services (HHS) and its mission is to protect the integrity of HHS programs like Medicare and Medicaid. In April, the OIG released a report that examined electrodiagnostic testing performed by physicians who were deemed to have high billing using 2011 EMG claims data. The AAN has learned that electrodiagnostic tests were targeted because the growth of Medicare spending on these tests outpaced the growth in overall Medicare spending in recent years. As a result, electrodiagnostic testing has been identified as an area vulnerable to fraud, waste, and abuse.

AAN leadership is working to gather a better understanding of the methodology that was used to compare neurologists to other neurologists as areas of subspecialization or patient focus may not have been considered. We are weighing our options carefully and have not ruled out a meeting with OIG or CMS. In the interim, the AAN has created a frequently asked questions document about the report and what to do should you receive a Comparative Billing Report.

Odds and Ends
The AAN recently released the 2014 Neurology Compensation and Productivity Report. The report—based on data from nearly 900 neurologists—shows trends in neurologists’ salaries and productivity. Some highlights:

  • US practicing neurologists report their median salary at $240,000.
  • The percent change in work relative value units outpaced the percent change in compensation over the two years, meaning that neurologists worked more but were paid relatively less in 2013 compared to 2012. 
  • While 85 percent of neurologists indicated they had on-call duties, only 24 percent were paid for the service.

The Neurology Compensation and Productivity Report represents an exclusive source of compensation and productivity data specific to neurology. The customizable online database allows data to be sorted by filters such as region, subspecialty, and practice type. The report and interactive database are available for purchase, and complimentary to all survey participants.

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