Kara Cronan

September 10, 2020

CMS Expands COVID-19 Telehealth Provisions to Skilled Nursing Facility Residents

CMS Expands COVID-19 Telehealth Provisions to Skilled Nursing Facility Residents The current COVID-19 public health emergency does not waive any requirements related to Skilled Nursing Facility (SNF) Consolidated Billing (CB); however, the Centers for Medicare & Medicaid Services added CPT codes 99441, 99442, and 99443 to the list of telehealth codes coverable under the waiver during the COVID-19 public health emergency. These codes designate three different time increments of telephone evaluation and management service provided by a physician. You can bill for these physician services separately under Part B when furnished to a SNF’s Part A resident. Medicare Administrative Contractors (MACs) will reprocess claims for CPT codes 99441, 99442 and 99443 with dates of service on or after March 1, 2020, that were […]
September 10, 2020

CMS Issues Proposed Rule for 2021 Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System

CMS Issues Proposed Rule for 2021 Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System On August 4, 2020, the Centers for Medicare & Medicaid Services (CMS) published the calendar year (CY) 2021 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule. Among notable changes, CMS proposes to pay the average sales price (ASP) minus 28.7 percent for 340B drugs; change the expansion exception process for a subset of physician-owned hospitals; expand the prior authorization process to include two new categories of services reimbursed under the OPPS; and eliminate the inpatient only list. Proposed Hospital Outpatient Department and ASC Payment Updates CMS proposes an increase of 2.6% for OPPS payment rates in CY […]
September 10, 2020

CMS Issues Proposed Rule for 2021 Medicare Physician Fee Schedule: Specific Impact to Spine Procedures

CMS Issues Proposed Rule for 2021 Medicare Physician Fee Schedule: Specific Impact to Spine Procedures PHYSICIAN PAYMENT PROVISIONS The 2021 Proposed Medicare Physician Fee Schedule Rule updated several policies and payment rates of relevance to ISASS members. Notably, budget neutrality adjustments have reduced the Conversion Factor associated with all CPT codes, from $36 per relative value unit (RVU) to $32 per RVU. This reduction, along with other code-specific adjustments, has impacted spine procedures by decreasing Medicare payments between 5% and 12%, compared with calendar year (CY) 2020 final rates. Public comments are being accepted by Centers for Medicare & Medicaid Services (CMS) between now and 5pm Eastern on October 5. Comments may be submitted electronically via this link. ISASS encourages its […]
September 10, 2020

ISASS Comments on Independence Blue Cross Spinal Fusion Policy

ISASS Comments on Independence Blue Cross Spinal Fusion Policy On August 25, 2020, ISASS sent a comment letter to Independent Blue Cross (IBC), the Blue Cross affiliate for the Greater Philadelphia area, regarding their recent Spinal Fusion Policy. The IBC policy calls for attestation of failure of conservative treatment by a physiatrist.  The letter from Dr. Frank Phillips, ISASS president, stated “ISASS believes that this intrusion has already been shown to create significant barriers to efficient care. ISASS questions the Level of Evidence supporting an additional consultation with a physiatrist to document that a patient has exhausted nonsurgical options. ISASS further maintains that the spine surgeon, rather than the physiatrist, is solely capable of the surgical decision making required to […]