Public Policy

August 28, 2019

CMS Seeks Input From Physicians and Practices on Impact of Prior Authorization

Centers for Medicare and Medicaid Services Administrator Seema Verma has tasked her Patients Over Paperwork team with exploring what CMS can do to improve Prior Authorization (PA) burdens as part of the eighth topic addressed under the initiative. They are conducting many listening sessions with various stakeholders over the next few weeks, including a wide range of providers and health plans, to gather information on burdens and suggestions on what CMS can do on this issue. They are also visiting practices to observe the PA process in action. In this effort, CMS is looking for data on PA. They are particularly interested in the following data points in advance of taking meaningful action: Practice costs to complete PA tasks, particularly […]
August 23, 2019

ISASS asks members to submit letter to CMS

This is in regard to the 2020 Medicare Physician Fee Schedule Proposed Rule, released by the Centers of Medicare and Medicaid Services (CMS) on July 29, 2019.  Specifically, the proposed rule proposed a recommended work Relative Value Unit (RVU) of 9.03 of 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.  In the proposed rule, CMS indicated they were seeking comment on whether to adopt a work RVU of 20.00 which is the work RVU for CPT code 27280, Arthrodesis, open, sacroiliac joint, including obtaining bone graft, including instrumentation, when performed to achieve site-of-service parity and eliminate incentives for facilities to use a […]
July 31, 2019

Centers for Medicare and Medicaid Services Issues a Proposed Rule for the 2020 Outpatient Prospective Payment System

On July 29, CMS published the proposed Physician Fee Schedule Rule for the 2020 Outpatient Prospective Payment System. The proposed changes encourage site-neutral payment between certain Medicare sites of services as well as proposing updates and policy changes under the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System. According to CMS, the proposed polices in the CY 2020 OPPS/ASC Payment System proposed rule would further advance the agency’s commitment to increasing price transparency—including proposals for requirements that would apply to each hospital operating in the United States)—rethinking rural health, unleashing innovation, reducing provider burden, and strengthening program integrity so that hospitals and ambulatory surgical centers can operate with better flexibility, and patients have what […]
July 30, 2019

CMS Proposes to Maintain Current Value for Minimally Invasive SI Joint Spine Fusion But Will Consider Alternative Values

In the July 29, Medicare Physician Fee Schedule Proposed Rule, CMS indicated a proposed value 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 of 19.88 Total RVUS which maintains the current value of 27279. ISASS had previously asked CMS to reconsider the value of this CPT code as “misvalued,” and CMS agreed that it may be misvalued and assigned a review of the value by the AMA RUC.  ISASS, along with other medical societies—icluding NASS, AANS, and AAOS—conducted a physician survey and recommended increasing the RVUs for 27279.  The RUC, however, did not accept this recommendation and CMS cited the RUC’s […]