June 10, 2020

HHS CMS Releases Proposed Rule for Inpatient Prospective Payment System (IPPS) for 2020/2021

On May 11, the Trump Administration proposed changes for acute care and long-term care hospitals that build on the progress made over the past 3 years and further the agency’s priority to transform the health care delivery system through competition and innovation while providing patients with better value and results. The proposed rule would update Medicare payment policies for hospitals paid under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) for FY 2021. CMS is proposing a separate new hospital payment category for Chimeric Antigen Receptor (CAR) T-cell therapy. CAR-T is the first-ever gene therapy, and it uses a patient’s own genetically modified immune cells to treat people with certain types of […]
June 10, 2020

ISASS Provides Extensive Additional Comments to Anthem on Sacroiliac Joint Fusion Coverage Policy During Call and Response Letter

On May 26, 2020, ISASS sent a comment letter to Anthem regarding their Sacroiliac Joint Fusion Coverage Policy, which is used in many states/regions by Anthem for fee schedule and coverage policies. The ISASS letter asked that Anthem revise their coverage policy to consider inclusion of coverage of minimally invasive sacroiliac joint fusion, which would be consistent with ISASS recommendations for appropriate criteria for sacroiliac joint fusion procedures and criteria on nonsurgical options. The May 26 letter was sent as a follow-up to a call on May 18, 2020, with ISASS Coding and Reimbursement Task Force Chair, Morgan Lorio, MD, and David Polly, MD, and the Anthem Coverage Policy team, led by John Whitney, MD. Read the ISASS 5-26-20 Anthem […]
May 1, 2020

The Department of Health and Human Services (HHS) Provides an Update on the Provider Emergency Relief Fund

On April 24, 2020, the Department of Health and Human Services (HHS) announced additional support to healthcare providers fighting the COVID-19 pandemic through the bipartisan CARES Act that provides $100 billion in relief funds to hospitals and other healthcare providers impacted by the coronavirus response. This funding will be used to support healthcare-related expenses or lost revenue attributable to COVID-19 and to ensure uninsured Americans can get treatment for COVID-19. In allocating the funds, the Administration is working, among other things, to address both the economic harm across the entire healthcare system due to the stoppage of elective procedures, as well as the economic impact on providers incurring additional expenses caring for COVID-19 patients, and to do so as transparently […]
May 1, 2020

HHS CMS Announces Evaluation of Amounts and Timing of Payments Under Its Accelerated Payment Program and Suspending the Advance Payment Program

HHS CMS Announces Evaluation of Amounts and Timing of Payments Under Its Accelerated Payment Program and Suspending the Advance Payment Program On April 26, the Centers for Medicare & Medicaid Services (CMS) announced that it is reevaluating the amounts that will be paid under its Accelerated Payment Program and suspending its Advance Payment Program to Part B suppliers effective immediately. The agency made this announcement following the successful payment of over $100 billion to health care providers and suppliers through these programs and in light of the $175 billion recently appropriated for health care provider relief payments. CMS had expanded these temporary loan programs to ensure providers and suppliers had the resources needed to combat the beginning stages of the […]