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. (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 those spine codes CMS proposes to add to the ASC list of covered surgical procedures. Click here for a list of spine codes and their corresponding payment […]
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.