August 9, 2021

CMS Prior Authorization of Cervical Fusion Procedures Began in July 2021

CMS Prior Authorization of Cervical Fusion Procedures Began in July 2021 Despite continued efforts by stakeholders to eliminate or delay the implementation of Prior Authorization review in the outpatient prospective payment system (OPPS) settings for cervical fusion and spinal neurostimulator implantation procedures, the review began on July 1, 2021. With the initiation of the policy, it will be important to track and share information related to the addition of cervical fusion with disc removal and implanted spinal neurostimulators to the nationwide prior authorization process for hospital outpatient department services. This tracking will be vital for appropriate oversight to ensure beneficiary access is maintained and an efficient process is established for both providers and beneficiaries. ISASS will work to provide input to CMS and […]
August 5, 2021

CMS Releases 2022 Outpatient Prospective Payment System/Ambulatory Surgical Center Proposed Rule

CMS Releases 2022 Outpatient Prospective Payment System/Ambulatory Surgical Center Proposed Rule On July 19, 2021, CMS published a proposed rule for the 2022 calendar year (CY) Medicare Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) settings. The OPPS/ASC Schedule sets the annual payment rates, policies, and regulations related to Outpatient Facilities and Ambulatory Surgical Centers. On July 19, 2021, the Centers for Medicare & Medicaid Services (CMS) proposed Medicare payment rates for hospital outpatient and Ambulatory Surgical Center (ASC) services. The CY 2022 Hospital Outpatient Prospective Payment System (OPPS) and ASC Payment System Proposed Rule is published annually and will have a 60-day comment period, which will end on September 17, 2021. The final rule with comment period […]
August 5, 2021

CMS Releases 2022 Medicare Physician Fee Schedule Proposed Rule

CMS Releases 2022 Medicare Physician Fee Schedule Proposed Rule On July 13, 2022, CMS published a proposed rule for the 2022 calendar year (CY) Medicare Physician Fee Schedule (PFS). The Medicare Physician Fee Schedule sets the annual payment rates, policies, and regulations related to physician practices. Comments in response to the letter will be due September 13, 2021. Since 1992, Medicare payment has been made under the PFS for the services of physicians and other billing professionals. Physicians’ services paid under the PFS are furnished in a variety of settings, including physician offices, hospitals, ambulatory surgical centers (ASCs), skilled nursing facilities and other post-acute care settings, hospices, outpatient dialysis facilities, clinical laboratories, and beneficiaries’ homes. Payment is also made to […]
July 6, 2021

AMA House of Delegates Calls on Medicare Advantage to Align Prior Authorization Policies with Medicare Fee-for-Service

AMA House of Delegates Calls on Medicare Advantage to Align Prior Authorization Policies with Medicare Fee-for-Service   The American Medical Association (AMA) House of Delegates issued a statement saying that Medicare Advantage plans shouldn’t override physician judgment. According to a resolution presented at the AMA Special Meeting, more than 62 million Americans are covered by Medicare Advantage plans, yet such plans may not follow Medicare guidelines for hospital admissions, diagnostic testing, medication, and procedures, putting many—especially those with “long COVID”—at risk for being denied treatment. To ensure that patients covered by Medicare Advantage plans are not denied necessary treatment, delegates directed the AMA to: Ask the CMS to further regulate Medicare Advantage plans so that the same treatment and authorization […]