July 6, 2021

CMS Responds to Request for Delay of Prior Authorization of Cervical Fusion Procedures

CMS Responds to Request for Delay of Prior Authorization of Cervical Fusion Procedures In a letter dated June 3, 2021, CMS’ Director of Provider Compliance, Connie Leonard responded to an April 7, 2021, letter from a coalition of healthcare stakeholders, including ISASS, asking CMS to delay implementation of prior authorization in the ambulatory surgical center (ASC) and outpatient prospective payment system (OPPS) settings for cervical fusion and spinal neurostimulator implantation procedures, which are scheduled to begin on July 1, 2021. CMS informed the coalition they would not further delay implementation of the prior authorization beyond July 1, stating in their letter that they believe Medicare Administrator Contractors (MACs) are properly equipped to carry out the prior authorization reviews. Ms. Leonard’s […]
July 6, 2021

Medicare Administrative Contractors Announce Resumption of Payment Reviews Beginning in August 2020

Medicare Administrative Contractors Announce Resumption of Payment Reviews Beginning in August 2020 Beginning August 2020, Medicare Administrative Contractors (MACs) resumed post-payment reviews of items and services with dates of service before March 2020. MACs may now begin conducting post-payment medical reviews for later dates of service. The CMS Targeted Probe and Educate program (intensive education to assess provider compliance through up to three rounds of review) will restart later. The MACs will continue to offer detailed review decisions and education as appropriate. Please contact your local MAC for more information on their payment reviews in your Medicare area.  
July 6, 2021

CMS Post-performance Information From the 2019 Quality Payment Program

CMS Post-performance Information From the 2019 Quality Payment Program As of June 2021, the CMS has made available newly added Quality Payment Program (QPP) performance information for physicians, clinicians, groups, and Accountable Care Organizations (ACOs) to the Doctors and Clinicians section of Medicare Care Compare and in the Provider Data Catalog (PDC). CMS is required to report eligible clinicians’ Merit-based Incentive Payment System (MIPS) Final Scores, eligible clinicians’ performance under each MIPS performance category, names of eligible clinicians in Advanced Alternative Payment Models, and, to the extent feasible, the names and performance of such Advanced APMs. Performance information for physicians and clinicians is displayed using measure-level star ratings, performance scores measured by percentage, and checkmarks. Medicare patients and caregivers can use the Care […]
June 3, 2021

Bill Introduced in Congress to Limit Medicare Advantage Prior Authorization

Bill Introduced in Congress to Limit Medicare Advantage Prior Authorization On May 21, 2021, House Bill 3173 (117th Congress), which seeks to cut red tape on prior authorizations in Medicare was introduced. The bill would require Medicare Advantage plans to report approval and denial rates. The bill was introduced by Representative Larry Buchon, MD, and would require Medicare Advantage insurers to be more clear about their prior authorization policies, according to a group of House members. H.R.3173 would establish an electronic prior authorization process and would require the Department of Health and Human Services to create a process for real-time decisions for items and services routinely approved. It would require Medicare Advantage plans to report on their use of prior […]