News

Members of Congress Urge CMS Administrator to Not Apply Prior Authorization Requirements for Cervical Fusion On November 2, over 50 members of Congress sent a letter to CMS Administrator Seema Verma urging her to not extend prior authorization requirements for cervical fusion procedures performed in the outpatient and ambulatory surgical center settings. CMS had previously announced in the Outpatient Prospective Payment System/Ambulatory Surgical Center proposed rule an intention to apply prior authorization to cervical fusion procedures, as well as spinal neurostimulator system procedures. In their letter, the members of Congress indicated disagreement with the CMS proposal and indicated that implementation of prior authorization would lead to delays in treatment for Medicare beneficiaries, which would negatively impact quality of life. The […]

AMA Announces Updated CPT codes and Instructions for E/M Office Codes for 2021 The American Medical Association (AMA) Current Procedural Terminology (CPT) Editorial Panel recently approved revisions to the CPT Evaluation and Management (E/M) office or other outpatient services codes, which will have significant implications on coding and documentation for these vital services. The changes are scheduled to go into effect January 1, 2021. In addition, CMS has approved updated Relative Value Unit settings for the E/M code set. The CPT changes are designed to reduce administrative burden and more accurately capture physician work involved in providing the services. Previously established changes include: For an outpatient visit with an established patient, a provider can record only what has changed since […]

CMS Releases Updated Rules on COVID-19 Vaccine and Therapeutics Proposed Rule On October 28, CMS finalized a fourth COVID-19 Interim Final Rule with Comment, which provides coverage and payment details for COVID-19 vaccines and therapeutics. Medicare will cover the cost of COVID-19 vaccines and their administration and will waive out-of-pocket costs for both traditional fee-for-service beneficiaries and beneficiaries enrolled in Medicare Advantage plans. Medicare will pay physicians $28.39 to administer coronavirus vaccines. For vaccines that require two doses, Medicare will pay $16.95 for the first dose and $28.39 for the second dose. These rates will be geographically adjusted. The rule also requires Medicaid, Children’s Health Insurance Program agencies, and most private health plans to administer the vaccine at no cost to patients […]

CMS Releases Updated Rules on Payer Transparency and Pricing On October 29, CMS finalized its Transparency in Coverage rule. The final rule is part of a larger effort to ensure price transparency across the healthcare sector. The Transparency in Coverage rule moves to require significant public disclosures of the prices of items and services by private health insurers. The final rule has two key components: Requires group health plans and health insurance issuers in the individual and group markets to disclose to all participants/beneficiaries/enrollees cost-sharing information for covered items and services. This requirement will be phased in, with cost-sharing information for 500 “shoppable” services to be provided starting January 1, 2023, and cost-sharing for all items and services to be provided […]