News

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Mergers ISASS Signs On to Letter in Support of S. 2978 Open Payments Program – 2015 Financial Data Posted FDA Issues Draft Guidance on the Use of Real-World Evidence for Medical Devices   2017 Proposed Physician Fee Schedule On July 7, 2016, the Centers for Medicare & Medicaid Services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 […]

On July 6, 2016, the Centers for Medicare & Medicaid Services (CMS) released the 2017 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System policy changes, quality provisions, and payment rates proposed rule. CMS is accepting comments on the proposed rule through September 6, 2016. The final rule is expected to be released in early November 2016. (Please note that physician payment is made under the Physician Fee Schedule; hospitals are paid for outpatient services under the OPPS and ASCs are paid under the ASC payment system, both detailed in this rulemaking.) A full summary of the rule is available here, including a list of spine codes CMS proposes to remove from the inpatient-only list and […]

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 all sites of service. These services include but are not limited to visits, surgical procedures, diagnostic tests, therapy services, and specified preventive services. CMS will accept comments on the proposed rule until September 6, 2016, and will issue the final rule by November 1, 2016. To set payment rates, CMS evaluates three components of medical services/procedures: physician work, practice expense, and malpractice expense. Each component is assigned a […]

ISASS recently signed on to a multi-specialty letter to U.S. Senator John Barrasso, MD in support of the “Protect Continuing Physician Education and Patient Care Act” (S. 2978), which would protect the dissemination of peer and independent third-party reviewed services and products that improve patient care. The legislation clarifies a provision in the Sunshine Act (Act) that excludes “educational materials that directly benefit patients or are intended for patient use” from being reported under the Act. In interpreting and enforcing this provision, the Centers for Medicare and Medicaid Services (CMS) concluded that medical textbooks, reprints of peer-reviewed scientific journal articles and abstracts are not directly beneficial to patients and not intended for patient use, and therefore must be reported under […]