HP-Update 11-9-2011

November 9, 2011

Dear Colleague:

We want you to know the highlights of the Academy's regulatory advocacy and the latest updates in business of medicine affecting the specialty and your patients. The Physician Payment Policy Workgroup (3P), led by Co-Chairs Richard Waguespack, MD and Michael Setzen, MD, along with your AAO-HNS Health Policy Team, are working hard to advocate for you on socioeconomic and practice affairs.


United Offers Direct-to-Consumer Hearing Tests and Aids
A United Healthgroup (UHG) subsidary announced in early October that it will be dispensing hearing aids at a deep discount for patients by "eliminating intermediaries" that drive up cost and will be providing free self-rendered hearing tests online. United and its subsidiary, hi HealthInnovations, said "intermediaries" doesn't refer to physicians, and that the company will encourage patients to see their doctors for certain hearing problems. The Academy has drafted a formal comment letter to the Medical Director at United Healthcare (UHC). Health Policy staff is currently working on scheduling a call to discuss our comments with UHG. For more information on this issue and to see the letter, please visit our Private Payer Advocacy webpage.

Cahaba GBA Changes "Once in a Lifetime" Policy Following Academy Advocacy
The Academy wrote to Cahaba GBA, objecting to the placement of several procedures under its "Once in a Lifetime" policy including Arytenoidopexy, Tonsillectomy and Adenoidectomy. Due to the advocacy of the Academy, Cahaba GBA agreed to remove these procedures from its "Once in a Lifetime List." Click for more information.

Academy Representatives Discuss Balloon Sinus Ostial Dilation Reference Medical Policy with Blue Cross and Blue Shield Association
Members of 3P and Academy staff had a conference call with Blue Cross and Blue Shield Association Technical Evaluation Center staff to discuss the classification of Balloon Sinus Ostial Dilation as investigational and not medically necessary. Learn more about the discussion and the Academys efforts here.

Medicare Physician Fee Schedule (MPFS) Final Rule
CMS issued the final MPFS for CY2012. In the final rule, CMS estimates a 27.5% reduction in Medicare payment compared to CY2011 due to the Sustainable Growth Rate (SGR) if Congress does not intervene. The Academy has repeatedly called for the replacement of the SGR. CMS also responded to some of the Academy's comments to CMS on the proposed rule. See the Academy's comments here.To note, CMS decided not to change the proposed lower values for thyroid/parathyroid and submandibular gland excision codes, maintaining its position that physician outpatient work following a 23 hour stay is less intense than inpatient work. CMS believes the valuation of the codes that fall into the 23 hour stay category should not reflect physician work associated with inpatient services. Also, CMS decided to reduce the sinus ostial dilation (CPT 31295-31297) practice expense values of the sinus surgery balloon supply kits to 0.5 units per procedure on an interim basis for 2012. Health Policy staff is reviewing the rule and plans to summarize in depth for members and submit comments to CMS on issues of continued concern by the January 3, 2012 deadline. More information will be available via The News and on the website in upcoming weeks.

Accountable Care Organization Final Rule Released by CMS
CMS issued the final rule for the Accountable Care Organization (ACO) program. The Academy previously commented on the proposed rule. See the Academy's comments here. To see a brief chart from CMS describing changes to the program in the final rule and for more information on ACOs, visit the Academy's Medicare Updates Website.

Business of Medicine

The Academy Needs Experts for RUC Survey: CPT Code 31231, diagnostic nasal endoscopy
The Academy must re-survey 31231 Diagnostic nasal endoscopy code in preparation for the January 26-29, 2011 RUC meeting. Your participation in the survey process is critical to the Academy's efforts in establishing Relative Value Units (RVUs) for this procedure code. Have you performed 31231 in the past year? Are you willing to participate in the RUC survey? Please indicate answers to both questions in an email to healthpolicy@entnet.org with your name and email address if you have not already done so. The survey will be sent to you within the next few weeks. For more information, visit our RUC webpage.

ICD-10 Transition
The Version 5010 compliance deadline is less than 60 days away. All entities covered under the Health Insurance Portability and Accountability Act (HIPAA) must be ready to implement the new health care electronic transactions standards version 5010 transaction standards by December 31, 2011. In order to meet this compliance deadline, providers will be required to conduct both Level I Internal Testing and Level II External Testing transactions. For more information on transitioning from 4010/4010A to the 5010 transaction standards on the ICD-10 transition, visit the CMS' 5010 ICD-10 page or the Academy's ICD resource page.

For more Health Policy news, see the Bulletin online (login required) or visit the Academy's webpage.

Upcoming Coding Workshops
Presented by the American Academy of Otolaryngology—Head and Neck Surgery Foundation in conjunction with Karen Zupko & Associates, Inc.
Chicago, IL November 11-12
Dallas, TX January 20-12
Las Vegas, NV February 17-18

AAO-HNS Coding Hotline
The Academy offers a coding hotline as a free service to members of the Academy. If you have coding questions or need guidance, this resource can help you!
9 am- 6 pm EST Monday through Friday


Rodney Lusk, MD

For more information, contact the AAO-HNS Health Policy Team at healthpolicy@entnet.org or visit http://www.entnet.org/Practice/CMS-News.cfm.


HP Update Issue Archive
HP-Update 2-7-2012
HP-Update 6-29-2011