August 28, 2019

CMS Issues Final Rule on Inpatient Prospective Payment System

On Aug. 2, CMS finalized policy changes to spur competition and innovation that will help deliver improved care and outcomes at a better value to patients. The final rule updates Medicare payment policies for hospitals under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) for fiscal year 2020 and advances two key CMS priorities—“Rethinking Rural Health” and “Unleashing Innovation” by making historic changes to how Medicare pays hospitals. This final rule: Increases the wage index for certain low-wage index hospitals, including many rural hospitals Increases Medicare add-on payments for high-cost eligible new technologies from 50% to 65% Clarifies policies on “substantial clinical improvement” to qualify for new technology add-on payments Provides an […]
April 30, 2019

Trump Administration Calls for Medicare/Medicaid Cuts, Program Reforms in FY 2020 Budget Proposal

The Trump Administration’s proposed fiscal year (FY) 2020 budget includes extensive health-policy provisions. Medicare, Value-Based, and Related Reforms The Administration estimates that its Medicare policy reforms would save approximately $811 billion over 10 years. The Administration states that these proposals are “designed to improve value-based systems of care, exercise fiscal integrity, promote competition, reduce provider burdens, improve the appeals system, and address high drug prices.” Budget provisions that would result in significant Medicare savings include the following (savings are over the 10-year period of FYs 2020-2029):  Site neutral payments between on-campus hospital outpatient departments and physician offices for certain services (e.g., clinic visits). [$131.4 billion] Payment for all off-campus hospital outpatient departments under the physician fee schedule (PFS) effective CY 2020. [$28.7 billion] Expansion of […]
March 28, 2019

Medicare Reduces Payments to 800 Hospitals Citing Patient Safety Incidences

Medicare announced on March 1, 2019, that 800 hospitals will be paid less by Medicare this year because of high rates of infections and patient injuries. The number is the highest since the federal government five years ago launched the Hospital Acquired Conditions (HAC) Reduction Program, created by the Affordable Care Act. This year, 110 hospitals are being punished for the fifth straight time. The penalties pit hospitals against one another in a race to prevent the most infections, blood clots, cases of sepsis, bedsores, hip fractures and other complications. Each year, the quarter of general hospitals with the highest rates are punished, even if their records have improved from the previous year. Under the announced sanctions, each hospital will lose 1 […]
March 28, 2019

ISASS Meets with the Office of Management and Budget (OMB) Officials Regarding Reimbursement of Minimally Invasive Spine Surgery

ISASS Coding and Reimbursement Task Force Chair Dr. Morgan Lorio participated in a meeting with officials from the Office of Management and Budget (OMB) to discuss reimbursement of minimally invasive spine surgery procedures in the Medicare Physician Fee Schedule. The meeting occurred March 19, 2019, and was focused on the undervaluation of spine surgical procedures in the Medicare Physician Fee Schedule. Dr. Lorio described two clear examples of mis-valuation of minimally invasive spinal procedure in CPT code 27279, Minimally Invasive Sacroiliac Joint Fusion, and 22867, Interlaminar Spinal Stabilization. The Centers for Medicare and Medicaid Services (CMS) have already identified as potentially misvalued in previous Medicare Physician Fee Schedules but have not changed the Relative Value Units (RVUs) for 27279. OMB […]