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ISASS Policy & Advocacy News – September 2016   News and noteworthy information for September 2016: MACRA Update: Pick Your Pace Novitas Draft LCD: Percutaneous Vertebroplasty and Vertebral Augmentation FDA Announces Voluntary Payer Participants for Device Pre-Submission Meetings PQRS Negative Payment Adjustment Notification Physicians Spend Nearly Twice as Much Time on EHR/Desk Work as Patients   MACRA Update: Pick Your Pace On September 8, 2016, Acting CMS Administrator Andy Slavitt announced the Centers for Medicare and Medicaid Services’ (CMS) plans to allow flexibilities in participation in the Quality Payment Program for the first performance period that begins January 1, 2017. Slavitt acknowledged that the agency heard concerns expressed by physician organizations about the proposed start date for performance reporting by physicians under […]

On July 7, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a proposed 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 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. To set payment rates, CMS evaluates three components of medical services/procedures: physician work, practice expense, and malpractice expense. Each component is assigned a value also known as a relative value unit (RVU). The work RVU, practice expense RVU, and malpractice RVU are each multiplied […]

On July 6, 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 proposed 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.) A full summary of the rule is available here, including a list of spine codes CMS proposes to remove from the inpatient-only list and those spine codes CMS proposes to add to the ASC list of covered surgical procedures. Click here for a list of spine codes and their corresponding payment […]

News and noteworthy information for August 2016: Data Collection on Surgical Global Periods Patient Relationship Categories and Codes Anthem Coverage Policy Update – Cervical Total Disc Arthroplasty Multi-Society Letter to CMS – Refinement Panel ICD-10 “Grace Period” Flexibility Ends October 1 Opioid Letter from U.S. Surgeon General Maintenance of Skills Survey   Data Collection on Surgical Global Periods On August 25, the Centers for Medicare and Medicaid Services (CMS) hosted a Town Hall meeting to hear directly from the surgical community on its proposal to collect data on the number and level of post-operative visits during the surgical global period. Many surgical spine procedures are valued and paid for as part of global packages that include the procedure and the […]