Nikki Golden

December 1, 2019

CMS Issues Final Rule for 2020 OPPS/ASC Payment System

On Nov. 1, CMS issued a final rule for the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System. In accordance with Medicare law, CMS is updating OPPS rates for hospitals that meet applicable quality reporting requirements by 2.6 percent. This update is based on the projected hospital market basket increase of 3.0 percent minus a 0.4 percentage point adjustment for Multi-Factor Productivity (MFP). Using the hospital market basket, CMS is finalizing an update to the ASC rates for CY 2020 equal to 2.6 percent. The update applies to ASCs meeting relevant quality reporting requirements. This change is based on the projected hospital market basket increase of 3.0 percent minus a 0.4 percentage point adjustment […]
November 30, 2019

ISASS, Other Stakeholders Respond to the White House’s Executive Order on Medicare

ISASS was a signatory to a letter to the White House in response to the White House Executive Order issued on Oct. 3. President Trump issued an Executive Order on “Protecting and Improving Medicare for our Nation’s Seniors.”  Although the Executive Order does not provide legislative or regulatory specifications, it raises policy areas that the President believes must be addressed to improve the Medicare program. The Executive Order aims to expand enrollment in Medicare Advantage (MA) plans to make them more attractive to seniors than the traditional fee-for-service program. Within one year, the Secretary of Health and Human Services is asked to propose regulations and implement other administrative actions to provide more diverse and affordable MA options for seniors, by: Encouraging innovative MA […]
November 30, 2019

CMS Issues Final Rule for 2020 Medicare Physician Fee Schedule

In addition to the proposed RVU changes for CPT 27279, the 2020 Medicare Physician Fee Rule updated several policies of relevance to ISASS members. Payment is made under the Physician Fee Schedule (PFS) for services furnished by physicians and other practitioners in all sites of service. These services include, but are not limited to, office visits, surgical procedures, diagnostic tests, therapy services, and specified preventive services. In addition to physicians, payment is made under the PFS to a variety of practitioners and entities, including nurse practitioners, physician assistants, and physical therapists, as well as radiation therapy centers and independent diagnostic testing facilities. Payments are based on the relative resources typically used to furnish the service. Relative value units (RVUs) are […]
November 30, 2019

CMS Medicare Physician Fee Schedule Final Rule Increases Value for Minimally Invasive SI Joint Spine Fusion

In the 2020 Medicare Physician Fee Schedule Final Rule, released on Nov. 1, CMS finalized a work RVU of 12.13 for CPT code 27279, Arthrodesis, sacroiliac joint, percutaneous or minimally invasive (indirect visualization), with image guidance, includes obtaining bone graft when performed, and placement of transfixing device. The current (2019) work RVU for 27279 is 9.03 so the increase is 3.10 or approximately 33%.  In addition, the Total RVUS for CPT 27279 changed from 2019 to 2020 from 19.99 to 25.34. These increases have long been advocated by ISASS and other stakeholders. ISASS had submitted comments to CMS on the 2020 Medicare Physician Fee Schedule Proposed Rule in September, where CMS indicated a proposed value of 9.03 work RVU. At […]