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 services typically furnished in the periods immediately before and after the procedure.
Citing concerns with lack of data to verify and update the values of codes with global packages, CMS finalized a policy to transform all 10- and 90-day global codes to 0-day global codes beginning in 2018. Under this policy, CMS would have valued the surgery or procedure to include all services furnished on the day of surgery and paid separately for visits and services furnished after the day of the procedure. Subsequently, Congress enacted Section 523 of the Medicare Access and CHIP Reauthorization Act of 2015 prohibiting CMS from implementing this policy and requiring the agency to gather data on visits in the post-surgical period that could be used to accurately value these services. As part of this year’s proposed Physician Fee Schedule rule, CMS is proposing a three-pronged data collection strategy:
In order to collect claims-based data, CMS is proposing to require ALL physicians who furnish procedures with 10-day and 90-day global periods to report the number and level of pre- and post-operative visits using a new set of G-codes that distinguish between the setting of care and whether the services are furnished by a physician or by their clinical staff. Physicians would be required to report the G-codes for every 10 minutes dedicated to a patient before and after a procedure or surgery.
To read more about this administratively burdensome proposal and details on how to submit comments to CMS, click here.
As part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the Centers for Medicare and Medicaid Services (CMS) is required to establish patient relationship categories and codes in order to evaluate the resources used to treat patients. The ISASS Payment Models Subcommittee analyzed CMS’ proposal and provided comments to CMS on ways to improve the framework. CMS is required to post an operational list of categories and codes no later than April 10, 2017 to its website. Physicians must then begin to use the categories and codes on claims for items and services furnished to patients on or after January 1, 2018.
Effective August 18, 2016, Anthem updated its Cervical Total Disc Arthroplasty (cTDA) coverage policy (SURG.00055) so that patients covered by Anthem plans now have coverage for one- and two-level cTDA when certain patient selection criteria are met. Prior to this update, two-level cTDA was not considered medically necessary and therefore not a covered benefit under Anthem’s plans. ISASS submitted a comment letter to Anthem in June in support of coverage of one- and two-level cTDA when certain clinical indications are met and the cTDA is performed using an FDA approved device in a manner consistent with the FDA approval.
ISASS recently signed on to a multi-society letter to the Centers for Medicare and Medicaid Services (CMS) strongly recommending reinstatement of the Refinement Panel as a formal appeals process to review public comments, hear directly from practicing physicians, and independently recommend refinements to the values assigned to procedure codes. In 2011, CMS changed the focus of the Refinement Panel process from a broad appeals process to a narrow process triggered only by the availability of “new clinical information”. This means CMS is largely unaccountable and is free to make valuation decisions without having to provide compelling rationale when rejecting value recommendations from stakeholders.
On August 18, the Centers for Medicare and Medicaid Services (CMS) updated its guidance on ICD-10 claims auditing and quality reporting flexibility for Medicare Part B fee-for-service claims, noting that the flexibility will expire on October 1, 2016 as scheduled. As part of the transition to ICD-10, in July 2015, CMS announced a 12-month “grace period” (10/1/15-10/1/16) during which Medicare claims would not be denied or audited solely based on the specificity of the ICD-10 diagnosis codes provided, as long as the physician submitted an ICD-10 code from the appropriate family of codes. Beginning October 1, 2016, all CMS review contractors are able to use coding specificity as the reason for a denial or audit of a claim.
Over the next two weeks, the U.S. Surgeon General Vivek H. Murthy, MD, will be mailing letters to nearly 2.3 million physicians and other health professionals across the U.S. to raise awareness and further efforts to end the opioid overdose epidemic, specifically urging three things: “Number one is to sharpen their prescribing practices, to make sure that we are treating pain safely and effectively. Number two, it’s to connect people to treatment who need it, and right now we have a major treatment gap in this country that we have to close.” “The third is we’re asking clinicians to help us change how our country thinks about addiction.” Click here to read a copy of the letter.
Several of your surgical colleagues have designed a short survey regarding maintenance of surgical competence. If you have not already completed the survey, click here to answer five short questions. The results will be shared with the ISASS membership.