I had the opportunity to attend the national APMA CAC and PIAC meeting in Alexandria, Virginia, in November. I am your Pennsylvania Contract Advisory Committee (CAC) and Private Insurance Advisory Committee (PIAC) representative. A Contractor Advisory Committee Representative deals with Medicare changes to LCDs.

A Private Insurance Advisory Committee representative deals with changes in private insurance. Most of the 50 states attended this meeting.

We discussed multiple issues with Medicare and private insurance. The conversion factor this year is reduced by 2.18. However, this should have zero impact on podiatry payments. We hope this stays the same. I'll keep our membership posted with any changes.  

We discussed the proper use of modifiers, such as modifier 25, when a procedure and evaluation and management are done on the same day.  We also discussed callus care being kicked out on the same day as nail care for some insurances, like Aetna. APMA is working hard to continue monitoring this; supposedly, Aetna has fixed it. 

We discussed the new “Final Rule” in depth. This was passed to protect Medicare customers confused by Medicare Advantage plans. Advantage plans will no longer be able to offer less than what Medicare. So hopefully, the Advantage plans that only allow at-risk foot care four times a year will need to change this to the Medicare LCD guidelines in your area. 

Dr. Jeff Lehman talked to us about MIPS.

Members who want to file a QPP exception application must do sobefore January 2, 2024. You can find this application onwww.gpp.cms.gov. You will need to fill out why you have an extreme and uncontrollable circumstance that would not allow you to participate in MIPS this year.

I will keep our membership posted with any other further updates as APMA and PPMA continue to monitor issues with billing and reimbursements. Another great benefit of membership in PPMA!