September 2, 2021

Senate Passes Massive Infrastructure Bill That Includes Several Health Care Provisions

Senate Passes Massive Infrastructure Bill That Includes Several Health Care Provisions On August 10, 2021, the U.S. Senate, by a vote of 69-31, passed the Infrastructure Investment and Jobs Act, H.R. 3684. The 2,702-page legislation contains several relevant health care–related provisions, including a delay of the implementation of the rule eliminating the Anti-Kickback Statute safe harbor protection for Medicare Part D rebates. Rebate for Discarded Amounts of Medicare Part B Single-Dose Container or Single-Use Package Drugs First, the legislation requires manufacturers of single-dose container or single-use package drugs payable under Medicare Part B to provide a rebate to the government for any discarded portion of that drug. The rebates will be charged each quarter, beginning with the first quarter of 2023, and […]
September 2, 2021

CMS Releases 2022 Medicare Inpatient Prospective Payment System (IPPS) Final Rule

CMS Releases 2022 Medicare Inpatient Prospective Payment System (IPPS) Final Rule On August 2, 2021, CMS published a final rule for the 2022 Calendar Year Inpatient Prospective Payment System (IPPS) The final rule, effective October 1, 2021, authorizes additional payments for diagnostics and therapies to treat COVID-19 during the current public health emergency, and beyond. The rule revises payment policies, as well as policies under certain quality and value-based purchasing programs, for hospitals to lessen the adverse impacts of the pandemic. Some of these changes will incentivize the meaningful use of certified electronic health record (EHR) technology that will help public health officials monitor for future public health emergencies. CMS also finalized a number of other Medicare payment rules, including […]
August 9, 2021

Several Spine Surgery Procedure RVUs Reviewed as Part of the Medicare Physician Fee Schedule 2022 Proposed Rule

Several Spine Surgery Procedure RVUs Reviewed as Part of the Medicare Physician Fee Schedule 2022 Proposed Rule As part of the 2022 Medicare Physician Fee Schedule proposed rule, several sets of spinal surgical procedures were included as either new to the Physician Fee Schedule or existing services that were reviewed or revalued. Specifically, CMS reviewed new codes for Arthrodesis Decompression when performed with Fusion, new codes for Basivertebral Nerve Ablation (Intracept procedure), and a revised value for Insertion of Spinal Stabilization devices (Coflex). CMS proposed updating the Relative Value Units (RVUs) assigned to Current Procedural Terminology (CPT) 22867, “Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; single level” (Coflex). The current […]
August 9, 2021

CMS Prior Authorization of Cervical Fusion Procedures Began in July 2021

CMS Prior Authorization of Cervical Fusion Procedures Began in July 2021 Despite continued efforts by stakeholders to eliminate or delay the implementation of Prior Authorization review in the outpatient prospective payment system (OPPS) settings for cervical fusion and spinal neurostimulator implantation procedures, the review began on July 1, 2021. With the initiation of the policy, it will be important to track and share information related to the addition of cervical fusion with disc removal and implanted spinal neurostimulators to the nationwide prior authorization process for hospital outpatient department services. This tracking will be vital for appropriate oversight to ensure beneficiary access is maintained and an efficient process is established for both providers and beneficiaries. ISASS will work to provide input to CMS and […]