News

On October 2, National Government Services, Inc. (NGS), the Medicare Administrative Contractor covering Illinois, Minnesota, Wisconsin, Connecticut, New York, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont, released a positive draft Local Coverage Determination (LCD) for minimally invasive sacroiliac joint fusion (MIS SIJ fusion) and on October 16, CGS Administrators, LLC (CGS), the Medicare Administrative Contractor covering Kentucky and Ohio, released an identical positive draft LCD. Both draft LCDs reference ISASS prevalence data and coverage criteria for coverage of MIS SIJ fusion and propose coverage of the procedure when eight specific coverage criteria have been met. NGS is accepting public comments on the draft LCD until December 12, 2015. CGS is accepting public comments on the draft LCD until December […]

ISASS signed on to an AMA letter signed by more than 100 state and national medical specialty societies to Centers for Medicare and Medicaid Services (CMS) Acting Administrator Slavitt laying out principles CMS should follow in designing regulations to implement the Medicare Access and Chip Reauthorization Act (MACRA). The letter is in response to a CMS Request for Information (RFI) regarding the implementation of Alternative Payment Models (APMS) and Merit-Based Incentive Programs (MIPS) under MACRA. On September 28, CMS released an RFI seeking public comments on Section 101 of MACRA, which:  Repeals the Medicare Sustainable Growth Rate methodology for updates to the physician fee schedule (PFS) and implements scheduled PFS updates; Adds the new Merit-based Incentive Payment System (MIPS) for eligible professionals, sunsets payment […]

On October 30, 2015, The Centers for Medicare and Medicaid Services (CMS) released the Calendar Year (CY) 2016 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) final rule. The final rule updates Medicare payment policies and rates for: hospital outpatient departments (HOPDs); ASCs; and partial hospitalization services provided by community mental health centers (CMHCs). Additionally, the final rule makes refinements to quality reporting programs in these outpatient settings and makes changes to the Two Midnight Rule. The final rule goes into effect on January 1, 2016. CMS is accepting public comments on the final rule until 5 p.m. EST on December 29, 2015. Summary of Final 2016 Rule for ISASS Members

On October 30, 2015, the Centers for Medicare and Medicaid Services (CMS) released the final 2016 Physician Fee Schedule (PFS). In the final rule, CMS finalizes RVUs for Calendar Year (CY) 2016 for the PFS and other Medicare Part B payment policies to ensure that CMS payment systems are updated to reflect changes in medical practice and the relative value of services, as well as changes in the statute. This is the first PFS final rule since the repeal of the Sustainable Growth Rate formula by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The final rule goes into effect on January 1, 2016. CMS is accepting public comments on the final rule until 5 p.m. EST on December […]