On October 14, the Centers for Medicare and Medicaid Services (CMS) issued the final rule implementing the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA was bipartisan legislation signed into law in April 2015 to permanently repeal the Sustainable Growth Rate (SGR), streamline physician quality reporting programs, and provide incentive payments for physician participation in alternative payment models. MACRA sunsets the Physician Quality Reporting System (PQRS), the Value-Based Payment Modifier, and the Medicare Electronic Health Record (EHR) Incentive Program and establishes an umbrella Quality Payment Program with two new pathways for payment: 1. Merit-Based Incentive Payment System (MIPS) and 2. Advanced Alternative Payment Models (Advanced APMs). The new Quality Payment Program dramatically changes the way Medicare reimburses more […]
On November 1, 2016, the Centers for Medicare & Medicaid Services (CMS) released the 2017 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System policy changes, quality provisions, and payment rates final rule. Please note that physician payment is made under the Physician Fee Schedule; hospitals are paid for outpatient services under the OPPS and ASCs are paid under the ASC payment system, both detailed in this rulemaking. For 2017, CMS is updating OPPS rates by 1.65 percent. After considering all other policy changes proposed under the OPPS, including estimated spending for pass-through payments, CMS estimates a 1.7 percent payment increase for hospitals paid under the OPPS in 2017. ASC payments are annually updated by the percentage […]
On November 2, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates payment policies, payment rates and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2017. The PFS pays for services furnished by surgeons, physicians, and other practitioners in all sites of service. These services include but are not limited to visits, surgical procedures, diagnostic tests, therapy services, and specified preventive services. As part of the final rule, CMS assigned final values to the following new surgical spine codes set to take effect January 1, 2017: Code Descriptor 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring […]
On November 1, HCSC (BCBS Illinois, BCBS Montana, BCBS New Mexico, BCBS Oklahoma, BCBS Texas) posted a draft updated lumbar fusion medical policy for comment through November 16. The draft policy establishes conditions for which lumbar spinal fusion may be considered medically necessary by HCSC. ISASS submitted comments specific to HCSC’s designation of lumbar fusion to treat degenerative disc disease (DDD) as not medically necessary and provided HCSC with a copy of the Society’s lumbar fusion policy. The final policy will be released by HCSC in the coming weeks.