September 30, 2019

GAO Indicates Medicare quality measures need improvement

Center for Medicaid and Medicare Services quality measures might not measure or capture the actual care patients receive, according to a new Government Accountability Office (GAO) report. The GAO studied how the agency decides what quality measures to develop and use. It also evaluated how CMS monitors its funding for quality measurement activities. The GAO report stated that CMS doesn’t have processes to ensure that the indicators actually measure what the agency says it cares about in its strategic objectives. The GAO also found that the CMS carries over large sums of unused funds each year for activities related to quality measurement and that the CMS fails to keep track of all its quality-measurement funding. The report recommends that CMS should create standard […]
September 30, 2019

CMS Receives Input on Prior Authorization Regulations

CMS Administrator Seema Verma has tasked her Patients Over Paperwork team with exploring what CMS can do to improve Prior Authorization (PA) burdens as part of the eighth topic addressed under the initiative. In addition, stakeholders like ISASS and other medical specialty societies have submitted input in writing on the issue. ISASS has been a signatory to an AMA taskforce report on Prior Authorization impacts and continues to work closely with the AMA and other medical specialties. These stakeholders submitted a letter to Administrator Verma on September 19. ISASS and other signatories are concerned that the CMS initiatives are too heavily focused on automation and technology and are not addressing other areas of importance as outlined in the Prior Authorization […]
September 30, 2019

ISASS Comments on Medicare Physician Fee Schedule CY 2020 Proposed Rule, Address Misvaluation of 27279

On September 23, ISASS submitted comments to the Centers for Medicare and Medicaid Services (CMS) on their proposed rule for CY 2020 for the Medicare Physician Fee Schedule (released on July 29). The ISASS letter addressed several issues of relevance to ISASS member reimbursement regulation, including the Medicare payment for CPT code 27279, Arthrodesis, sacroiliac joint, percutaneous or minimally invasive (indirect visualization), with image guidance, includes obtaining bone graft when performed, and placement of transfixing device. In the proposed rule, CMS indicated a proposed value of 9.03 work RVU, but that they were seeking comment on whether to adopt a work RVU of 20.00 which is the work RVU for CPT code 27280, Arthrodesis, open, sacroiliac joint, including obtaining bone […]
August 29, 2019

UPDATED: ISASS Urges Changes to NCCI Edits for Spine Surgery

In a letter dated Aug. 16, ISASS responded to a decision by CMS and CMS’ NCCI Edit Contractor, Capital Bridge LLC, to not revise a set of  for CMS to consider changes to a set of National Correct Coding Initiative (NCCI) edits for CPT codes 22842, Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure), 22843, Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 7 to 12 vertebral segments (List separately in addition to code for primary procedure), 22844, Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 13 or […]