On Jan. 27, the Department of Justice announced the Electronic Health Record (EHR) technology developer is paying $145 million to settle allegations that Practice Fusion extracted unlawful kickbacks from pharmaceutical companies in exchange for implementing clinical decision support (CDS) alerts in its EHR software designed to increase prescriptions for their drug products. The CDS alerts that Practice Fusion agreed to implement did not always reflect accepted medical standards. In discussions with pharmaceutical companies, Practice Fusion touted the anticipated financial benefit to the pharmaceutical companies from increased sales of pharmaceutical products that would result from the CDS alerts. Between 2014 and 2019, health care providers using Practice Fusion’s EHR software wrote numerous prescriptions after receiving CDS alerts that pharmaceutical companies participated […]
In a letter submitted Feb. 10, 2020, Dr. Morgan Lorio, Chair of the ISASS Coding and Reimbursement Task Force, asked the Centers for Medicare and Medicaid Services (CMS) to review the Relative Value Units (RVUs) assigned to CPT 22867, Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; single level (Co-Flex) and identify the procedure as misvalued under the Medicare Physician Fee Schedule in the 2021 Medicare Physician Fee Schedule Proposed Rule. ISASS argued that the recent Medicare valuations of 22867 was undervalued by CMS in 2015 when it was added to the Medicare Physician Fee Schedule as a result of a flawed process and flawed assumptions made in the review process. […]
On January 15, ISASS was a signatory to a letter to CMS in response to a Request for Information issued by CMS after the White House Executive Order issued on Oct. 3, 2019. In that Executive Order, President Trump issued an Executive Order on “Protecting and Improving Medicare for our Nation’s Seniors.” While the Executive Order does not provide legislative or regulatory specifications, it raises policy areas that the President believes need to 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 […]
The Centers for Medicare and Medicaid Services (CMS) announced the finalization of a new framework for MIPS participation for the 2021 performance period. The goal of this new framework is to move away from siloed performance category measures and activities and toward an aligned set of measures and activities that are more meaningful to clinicians and patient care. CMS stated they will not immediately eliminate the current MIPS framework. They intend to develop MIPS Value Pathways for 2021 and beyond in collaboration with stakeholders, and ISASS will provide opportunities for dialogue and additional feedback. Read the Fact Sheet here.