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Public Policy and Advocacy

September 2015 - ICD-10 News

On August 31, ISASS staff participated on a National Provider Call hosted by the Centers for Medicare and Medicaid Services (CMS), “Countdown to ICD-10”, where CMS emphasized preparation, assistance and collaboration during the transition to ICD-10. As you already know, ICD-10 codes must be used for services provided on and after October 1, 2015. ISASS compiled relevant information and provided its members with an “ICD-10 Guide for Spine Practices” on August 21, 2015. Since that time, CMS named Dr. William Rogers as its ICD-10 Ombudsman.

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August 2015 - ICD-10 Guide for Spine Practices

ICD-10 will have a substantial impact on you and your practice however, you can mitigate some of the impact by developing an action plan and preparing your practice now. You should also know that you will have some flexibility in coding during the first year after the implementation of ICD-10.

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August 2015 - ICD-10 Is Coming. Are You Prepared?

For services provided on and after October 1, 2015, U.S.-based entities covered under the Health Insurance Portability and Accountability Act (HIPAA) are required to use ICD-10 code sets. ICD-9 codes will no longer be accepted on claims for services provided on or after October 1, 2015.

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August 2015 - CMS Releases Proposed 2016 Physician Fee Schedule - What You Need to Know!

The Social Security Act (the Act) requires the Centers for Medicare & Medicaid Services (CMS) to establish payments under the Physician Fee Schedule (PFS) based on national uniform relative value units (RVUs) that account for the relative resources used in providing a service. The Act requires that RVUs be established for three categories of resources: work, practice expense and malpractice expense. The Act also requires CMS to establish by regulation each year's payment amounts for all physicians’ services paid under the PFS, incorporating geographic adjustments to reflect the variations in the costs of furnishing services in different geographic areas. There are over 1 million physicians, other practitioners, and medical suppliers that receive Medicare payment under the PFS for more than 7,400 services.

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March 2015 - ISASS Policy Statement Update - Minimally Invasive Sacroiliac Joint Fusion 2015

The ISASS Coding & Reimbursement Task Force has been integrally involved with the genesis and evolution of MIS SI joint fusion, coding and reimbursement. This timely update supplements the ISASS policy statement published in the International Journal of Spine Surgery in 2014. The Task Force hopes that this tool will augment the armamentarium of our spine surgeons as we diligently advocate for access to coverage.

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March 2015 - ISASS Policy Statement - Lumbar Artificial Disc

The ISASS Task Force reached out to Jack Zigler, MD and Rolando Garcia, MD, MPH, FAAOS to provide a timely summation on lumbar disc arthroplasty given their considerable experience in the area in order to ensure enhanced spine patient access. The ISASS Task Force is pleased with this step towards published ISASS societal policy and applauds their work...

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August 2014 - ISASS Policy Statement - Minimally Invasive Sacroiliac Joint Fusion

The ISASS Coding and Reimbursement Task Force has been busy addressing our membership's needs while advocating spine access (further projects are in the pipeline). Our past MIS SIJ Policy was created early as MIS SIJ was evolving. The current body of literature is now more robust and a timely educational update for ISASS & IASP membership has been developed.

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June 2014 - ISASS Now a Member of AMA House of Delegates

Today after much hard work and diligence, ISASS was awarded a seat at the table of the House of Delegates (HOD) of the AMA. Gunnar Andersson, MD, PhD, ISASS President was handed a clicker and began voting on your behalf. "Today ISASS became a member of the AMA House of Delegates, this gives us a seat at the table of the organization that makes decisions at the [Current Procedural Terminology] and [Relative Value Scale Update] Committees," said Anderrson of this accomplishment.

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April 2014 - ISASS Responds to CBS Spinal Fusion Segment

CBS recently highlighted the fact that spinal fusions are increasingly common procedures and that indications in some cases are controversial. Their highlighting of "surgeons they looked into" presents a frightening picture of alleged abuses, of a procedure that in many cases is clinically indicated with excellent results.

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April 2014 - ISASS Policy Statement - Cervical Artificial Disc 2014

The ISASS Task Force reached out to Domagoj Coric, MD to provide a timely summation on cervical disc arthroplasty given his special interest and recent IASP championing of this innovative technology to ensure enhanced spine patient access. The ISASS Task Force is pleased with this step towards published ISASS societal policy and applauds Dr. Coric's effort; if ISASS is to continue to succeed we must continually harness the voluntary talents and energies of our members with gratitude.

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March 2014 - ISASS Statement on Coding Changes for Minimally Invasive SI Joint Fusion 2014

ISASS/IASP is fostering relationships with the payer community to keep them informed of guidelines that impact their members and policy decision making. ISASS/IASP continues to support access of medically necessary procedures to patients and support the spine practices of our member surgeons. The ISASS Statement on Coding Changes for Minimally Invasive SI Joint Fusion 2014 is another example.

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February 2014 - Introduction of SGR Repeal and Medicare Provider Payment Modernization Act of 2014

ISASS staff participated in a conference call conducted by the American Medical Association (AMA) in which the SRG Repeal Legislation was discussed. We felt ISASS members would want to review the information presented.

Staff for the chairmen and ranking minority members of the three Congressional committees of jurisdiction briefed physician groups this afternoon on the results of their bicameral, bipartisan negotiations on repealing the SGR. The “SGR Repeal and Medicare Provider Payment Modernization Act of 2014,” which was introduced by Rep. Michael Burgess, MD (R-TX) in the House as H.R. 4015, addresses only the policy provisions related to eliminating the flawed payment update formula. It does not include financial offsets or any of the usual extender policies.

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September 2013 - Spotlight on the Coding and Reimbursement Task Force

In response to continued downward pressure from government and commercial payers on spine surgery coverage and reimbursement, the ISASS Coding & Reimbursement Task Force continues to evaluate policies that may be detrimental to optimal patient care, and that may unnecessarily or punitively reduce physician reimbursement.

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September 2013 - Comments on CMS Proposed Rule (CMS-1600-P) – Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Medicare Part B for CY 2014

On behalf of the International Society for the Advancement of Spine Surgery (ISASS), I am writing to submit comments on the proposed Medicare Physician Fee Schedule (MPFS) for CY 2014. [...] Overall, we are very concerned with the proposal to cap payment rates for over 200 physician services at outpatient prospective payment system (OPPS) or ambulatory surgical center (ACS) rates. Such a proposal will reduce payment for some services by more than 50 percent, which will reduce or eliminate their utilization in physician offices, and will thus require patient to obtain such service in a more costly and less convenient setting.

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September 2013 - Comments on CMS Proposed Rule (CMS-1601-P) Section III(A) Regarding Changes to IDE Coverage Process

On behalf of the International Society for the Advancement of Spine Surgery (ISASS), below are comments submitted on CMS’ Proposed Rule, Revisions to Payment Policies under the Physician Fee Schedule, Clinical Laboratory Fee Schedule and Other Revisions to Part B for CY 2014.

ISASS is an international, scientific and educational society organized to discuss and assess existing strategies and innovative ideas in the clinical and basic sciences related to spine surgery to enhance patient care. Our comments focus specifically on proposed changes to the procedures and standards for Medicare coverage of items and services furnished during Investigational Device Exemption (IDE) clinical trials.

As a professional society dedicated to the treatment of spine disorders, our members often participate in prospective IDE clinical studies to evaluate the safety and clinical efficacy of new or emerging technologies or procedures. The proposed changes to the Medicare coverage process for these studies threaten the timely enrollment and execution of clinical trials, particularly with respect to spinal technologies. Below, we describe our concerns with the proposed changes and offer recommendations to better protect important clinical research.

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July 2013 - Statement on Coding Changes for Minimally Invasive SI Joint Fusion

ISASS supports decision making at the physician-patient level based on medical necessity and achieving the best outcomes to address the patient’s medical condition. Medical necessity should not be determined by a mere administrative code reporting system such as CPT. Prior to the July 1st implementation of CPT category III code 0334T, surgeons reported and were reimbursed for ALL sacroiliac joint fusion procedures when medically necessary, including minimally invasive, through the use of CPT code 27280.

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May 2013 - Domagoj Coric, MD Responds to BCBSNC “Let’s Talk Cost” Statement on Artificial Discs

I am writing you on behalf of International Advocates for Spine Patients (IASP) as well as the patient population of North Carolina. IASP is an organization supported by physicians and patients dedicated to advocacy for high quality, widely accessible and cost effective spine care for patients around the world. I am on the Board of IASP (a sister organization to the International Society for the Advancement of Spine Surgery-ISASS) which was formed in 2011 to complement ISASS’ educational and scientific mission through direct advocacy efforts on the behalf of spine patients. I have spent the last 30 years in NC, generally working in healthcare or related fields. [...] I am writing to express serious concerns about numerous factual inaccuracies and omissions on the Blue Cross Blue Shield of North Carolina “Let’s Talk Cost” web site.

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March 2013 - ISASS Statement on Vertebral Augmentation

To: ISASS Members and the General Spine and Medical Communities

It is estimated that over 1.4 million people will develop vertebral compression fractures every year (Johnell & Kanis 2006).  Many will be clinically insignificant or heal with non-operative treatment.  A large group will have persistent pain, kypholic deformity, weight loss, depression and a reduced quality of life.  (Old & Calvert 2004; Borgstrom et al. 2006; Suzuki et al. 2008).

Open surgical intervention is used when there is severe deformity, instability, or neurologic compromise. Vertebral augmentation such as Vertebroplasty (VP) and balloon kyphoplasty (BKP) are minimally invasive techniques used to treat painful vertebral compression fractures.  There is good evidence that these techniques can provide immediate and lasting pain relief (Berlemann et al. 2004; Grafe et al. 2005; Groh et al. 2005; Alvarez et al. 2006; DeNegri et al. 2007; Lovi et al. 2009; Schofer et al. 2009; Wardlaw et al. 2009; Klazen et al. 2010; Liu et al. 2010; Santiago et al. 2010; Boonen et al. 2011).  At the same time there is evidence that not all patients with vertebral compression fractures benefit from these procedures (Buchbinder et al. 2009; Kalmes et al. 2009; Rousing et al. 2009; Wardlaw et al. 2009; Klazan et al. 2010).  Technology assessment efforts and meta-analyses have arrived at different conclusions regarding the value of vertebral augmentation, but are based on different studies depending on the timing of analyses and publications (Taylor et al. 2006a,b; Hulme et al. 2006; Eck et al. 2007; AAOS 2010; Papanastassiou et al. 2011).

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