December 24, 2019

Congress Continues to Develop Surprise Billing Legislation

On Dec. 11, the House Ways and Means Committee issued an outline of that panel’s bipartisan proposal for addressing surprise medical bills. Some details are vague, and it could be after the holidays before we see legislative language. Nonetheless, the committee’s approach offers significant differences from the recently issued agreement reached between the House Energy & Commerce Committee and the Senate Health, Labor, Education, and Pension (HELP) Committee. Like other proposals, the Ways & Means plan would limit patients’ out-of-pocket costs to the amounts they would have owed if they had the opportunity to choose in-network physicians and facilities to provide their care. An independent dispute resolution (IDR) system is also included.  However, unlike other proposals, Ways & Means does not restrict […]
December 24, 2019

CMS Issues Proposed Rule on Medicaid Oversight

On Nov. 12, 2019, CMS released a proposed rule aimed at strengthening oversight and fiscal integrity in the Medicaid program. The proposal was published in the Federal Register on Nov. 18. The proposed rule seeks greater transparency and accountability in Medicaid fee-for-service provider payments; disproportionate share hospital payments; Medicaid program financing; supplemental payments; and health care-related taxes and provider-related donations. Comments on the proposed rule are due on Jan. 17, 2020. The last several years have seen a rapid increase in Medicaid spending from $456 billion in 2013 to an estimated $576 billion in 2016. Much of this growth came from the federal share that grew from $263 billion to an estimated $363 billion during the same period. Supplemental payments, […]
December 23, 2019

ISASS Policy Guideline– Surgical Treatment of Lumbar Disc Herniation with Radiculopathy

ISASS Policy Guideline – Surgical Treatment of Lumbar Disc Herniation with Radiculopathy Morgan Lorio, MD, FACS,1 Choll Kim, MD, PhD,2  Ali Araghi, DO,3 Jason Inzana, PhD,4 James J. Yue, MD5 1 Advanced Orthopedics – Altamonte Springs, Florida, 2 Spine Institute of San Diego – San Diego, California, 3 The CORE Institute – Sun City West,  Arizona, 4 Telos Partners, LLC – Denver, Colorado, 5 CT Orthopaedics; Frank H. Netter School of Medicine – Hamden, Connecticut   Abstract Lumbar disc herniation is a frequent cause of low back pain and radiculopathy, disability, and diminution in quality of life. While nonsurgical care remains the mainstay of initial treatment, symptoms that persist for prolonged periods of time are well-treated with discectomy surgery.  A […]
December 10, 2019

ISASS Guideline – Intraosseous Ablation of the Basivertebral Nerve for the Relief of Chronic Low Back Pain

ISASS Guideline – Intraosseous Ablation of the Basivertebral Nerve for the Relief of Chronic Low Back Pain Morgan Lorio1; Olivier Clerk-Lamalice2; Douglas P. Beall3; Terrence Julien4 1Advanced Orthopedics, Altamonte Springs, Florida; 2Beam Interventional & Diagnostic Imaging, Calgary, Canada; 3Clinical Radiology of Oklahoma, Edmond, Oklahoma; 4BayCare Medical Group, Tampa, Florida   Rationale This ISASS guideline is generated to respond to growing requests for background, supporting literature and evidence, and proper coding for intraosseous ablation of the Basivertebral nerve (BVN) for chronic low back pain (CLBP). Introduction Prevalence and Clinical Presentation Low back pain is the most expensive occupational disorder in the United States and the leading cause of disability worldwide1-3. Thirty percent of Americans have low back pain (LBP) at any […]