Reimbursement
Risk adjustment data validation ensures payment integrity and accuracy - and it affects what plans are paid.
Barring an appeals court decision overturning the rule, the mandate goes into effect on January 1, 2021.
PhRMA questions the cost savings and says the rule leaves safety considerations to state governments, rather than the required federal oversight.
The interim rule would cut drug reimbursements to hospitals by an average of 65% when fully phased in, the AHA says.
The old federal regulations burdened providers with added administrative costs and fear of financial consequences, CMS says.
Opponents say the rule will not lower drug prices, and some question whether it is legal, having bypassed the public comment process.
The letter warns that the new thresholds are too high and will force many clinicians to exit from APMs and revert back to fee-for-service.
Automating risk stratification kept patients out of the ER, giving financial incentive to move to an alternative payment model.
Earlier this year, the Pennsylvania health system implemented eICU support for more than 60 rooms within a week.
Payers, employers, organized medicine and researchers can alter the mounting financial and clinical barriers patients face, the AMA says.