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Mergers ISASS Signs On to Letter in Support of S. 2978 Open Payments Program – 2015 Financial Data Posted FDA Issues Draft Guidance on the Use of Real-World Evidence for Medical Devices 2017 Proposed Physician Fee Schedule On July 7, 2016, the Centers for Medicare & Medicaid Services (CMS)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