July 30, 2019

Centers for Medicare and Medicaid Services (CMS) Issues a Proposed Rule for 2020 Medicare Physician Fee Schedule

On July 29, CMS published the proposed Physician Fee Schedule Rule for 2020. In the proposed rule, the Centers for Medicare and Medicaid Services (CMS) has proposed several changes that will affect ISASS members: With the budget neutrality adjustment to account for relative value changes, as required by law, the proposed 2020 PFS conversion factor is $36.09, a slight increase above the 2018 PFS conversion factor of $36.05. CMS proposed payments for new structural allograft codes used in orthopaedic trauma and oncology services (new CPT codes, 209X3, Osteoarticular Allograft, 209X4, Hemicortical Intercannulary Allograft, and 209X5, Interarticular Intercannulary Allograft Complex) CMS proposed updated payments for plain film X-ray codes for spine (CPT codes 72020-72220) CMS proposed updated payments for Patient Office […]
July 30, 2019

U.S. Centers for Medicare and Medicaid Innovation Invites Applicants for New Direct Contracting Voluntary Payment Model

The Centers for Medicare and Medicaid Innovation (CMMI) has announced a series of new voluntary payment models and are seeking facilities and organizations interested in participating to submit an initial Level of Interest (LOI) by Friday, August 2. One of the models being tested is a Direct Contracting model. This model is one of a set of three voluntary payment model options aimed at reducing expenditures and preserving or enhancing quality of care for beneficiaries in Medicare fee-for-service (FFS). The payment model options create opportunities for a broad range of organizations to participate with the Centers for Medicare & Medicaid Services (CMS) in testing the next evolution of risk-sharing arrangements to produce value and high-quality health care. Building on lessons learned […]
July 30, 2019

U.S. Congress Takes Up Legislation Aimed at Addressing “Surprise Billing”

In July, the U.S. House of Representatives opened hearings and introduced legislation to address the issue of surprise billing entitled the “No Surprises Act” (H.R. 3630).  By July 17, the legislation had been subject to mark-up and amendments as well in the House Energy and Commerce Committee, which reported out the proposed legislation to the full House on a voice vote. An amendment offered by Rep. Raul Ruiz, MD (D-CA) and Rep. Larry Bucshon, MD (R-IN) was adopted to add an appeals provision. Appeals would be restricted to complex cases with a claim’s threshold of $1,250 (indexed to inflation). The threshold is designed to limit the number of appeals and thereby also retain a higher level of savings to offset the cost […]
July 30, 2019

White House Announces Efforts to Promote Greater Price Transparency For Prescription Drugs

On June 25, the White House announced an initiative to encourage greater transparency in drug pricing. President Trump signed an Executive Order on June 25, entitled “Improving Price and Quality Transparency in American Healthcare to Put Patients First.” The purpose of the order is to direct federal agencies to issue regulations to improve the transparency of health care prices and quality in order to create a more competitive marketplace and provide consumers with the information they need to make informed purchasing decisions.  More specifically, the executive order: Directs the Secretary of Health and Human Services (HHS) to issue regulations within 60 days that would require hospitals to publicly post standard charge information, including information based on negotiated rates, in an […]