Comments

The FEHBlog appreciates receiving reader comments on this blog.  Here are the FEHBlog’s responses to recent comments:

1. A commenter on the FEHBlog’s entry on Provider Non-Discrimination noted that the Senate Finance Committee report dated July 11, 2013 (to accompany S. 1284) directing the ACA regulators to expand the scope of the ACA’s provider non-discrimination rule (PHCS § 2706) as discussed in ACA FAQ XV  to include an any willing provider requirement, among other things, “was included in the omnibus. The Explanatory Statement that goes along with the Consolidated Appropriations Act includes language that gives the Senate report the force of the full bicameral managers.” The FEHBlog will be sure to check this out but the ACA regulators don’t perceive the Senate report as binding. What’s more the Federal Trade Commission has recognized that any willing provider laws are anti-competitive.

2. Another commenter asked “Want to know what you mean by this statement [ in last Tuesday’s Tidbits, you didn’t explain: Congress did enact its 17th Medicare Part B payment fix yesterday which is good news for the FEHBP due to its large cadre of annuitant members over age 65.”  The FEHBlog chose not to provide an explanation last Tuesday because he has plowed this ground before. But he is happy to plow it again. Absent this Congressional action, Medicare Part B payments to doctors would have dropped by over 20%. When an FEHB annuitant has Medicare Part B, the FEHB plan pays secondary to Medicare. The result of this change would have been an increase in secondary payments. When an FEHBP annuitant enrolled in a fee for service plan has declines Medicare Part B coverage, the FEHB Act (5 U.S.C. § 8904(b)) allows the FEHB plan to price doctors services using Medicare Part B pricing. In those cases, the FEHB plan’s payment would have dropped. A lot of members would have been effected. On the occasions, which have occurred over the past 15 years, when Congress missed this deadline and adopted the fix retroactively,a lot of administrative work was created. So it’s a big deal for FEHB plans. Hopefully Congress will pass a reliable permanent fix in lame duck session of Congress.

3. Another commenter asked what’s next now that Congress has delayed the ICD-10 coding compliance date. The short answer is that we all have to wait for guidance from the Centers for Medicare and Medicaid Services, which is the HHS agency responsible for administering and enforcing the HIPAA electronic transactions and code sets needs to provide guidance to the affected parties — health plans, health care providers, and healthcare clearinghouses as Modern Healthcare further explains in this helpful article.  Here’s a link to a relevant press release from the industry group WEDI.

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