News and noteworthy information for August 2016: Data Collection on Surgical Global Periods Patient Relationship Categories and Codes Anthem Coverage Policy Update – Cervical Total Disc Arthroplasty Multi-Society Letter to CMS – Refinement Panel ICD-10 “Grace Period” Flexibility Ends October 1 Opioid Letter from U.S. Surgeon General Maintenance of Skills Survey Data Collection on Surgical Global Periods On August 25, the Centers for Medicare and Medicaid Services (CMS) hosted a Town Hall meeting to hear directly from the surgical community on its proposal to collect data on the number and level of post-operative visits during the surgical global period. Many surgical spine procedures are valued and paid for as part of global packages that include the procedure and the […]
ISASS recently signed on to a multi-society letter to the Centers for Medicare and Medicaid Services (CMS) strongly recommending reinstatement of the Refinement Panel as a formal appeals process to review public comments, hear directly from practicing physicians, and independently recommend refinements to the values assigned to procedure codes. In 2011, CMS changed the focus of the Refinement Panel process from a broad appeals process to a narrow process triggered only by the availability of “new clinical information”. This means CMS is largely unaccountable and is free to make valuation decisions without having to provide compelling rationale when rejecting value recommendations from stakeholders. View the letter to CMS here.
As part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the Centers for Medicare and Medicaid Services (CMS) is required to establish patient relationship categories and codes in order to evaluate the resources used to treat patients. The ISASS Payment Models Subcommittee analyzed CMS’ proposal and provided comments to CMS on ways to improve the framework. CMS is required to post an operational list of categories and codes no later than April 10, 2017 to its website. Physicians must then begin to use the categories and codes on claims for items and services furnished to patients on or after January 1, 2018. Read the ISASS letter to CMS here.
News and noteworthy information for July 2016: 2017 Proposed Physician Fee Schedule 2017 Proposed Hospital Outpatient and ASC Rule Update on MACRA Implementation DOJ Sues to Block Health Insurer Mergers ISASS Signs On to Letter in Support of S. 2978 Open Payments Program – 2015 Financial Data Posted FDA Issues Draft Guidance on the Use of Real-World Evidence for Medical Devices 2017 Proposed Physician Fee Schedule On July 7, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that updates payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2017. The PFS pays for services furnished by physicians and other practitioners in […]