*NEW* CMS Issues 2014 Final Rules for the Medicare Physician Fee Schedule and Hospital Outpatient/Ambulatory Surgical Centers (12/6/2013)
On November 26 CMS released the final 2014 Medicare Physician Fee Schedule (MPFS) and Hospital Outpatient Prospective Payment System (HOPPS)/Ambulatory Surgical Centers (ASCs) rules. Key provisions within the MPFS include acceptance of 4 sinusitis measures for 2014 PQRS reporting and CMS’ retraction of their proposal to cap services paid more in the office at the outpatient or ASC rate. The Academy is reviewing both rules and will provide detailed summaries in the coming weeks. Links to both final rules are provided below.
CMS Provides Guidance for Filing Claims Following Recent SGR Fix (1/10/13)
Following the passage of legislation which will avoid the -26.5% cuts to Medicare payments for CY 2012, the Centers for Medicare and Medicaid Services (CMS) has issued guidance to providers regarding the filing of claims for January 2013. Specifically, CMS states they are reworking the 2013 Physician Fee Schedule to update the conversion factor (now $34.0230) and note that this process may require claims filed in early January to be held up for up to 10 business days (i.e. no later than January 15th, 2013). CMS expects these claims to be released into processing no later than January 16th. The claim hold should have minimal impact on physician/ practitioner cash flow because, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 for paper claims) after date of receipt. Claims with dates of service before January 1, 2013 are unaffected.
Medicare Contractors are expected to post the new payment rates to their websites no later than January 23rd. Practices can eithe defer to submission of their charges until the new payment rates are posted or continue charging 2012 rates to avoid being paid at the reduced 2013 rate. Practices should also wait to charge patients directly for cost-sharing amounts until the 2013 rates are posted, as relative value units and limiting charges could change. In the meantime, please contact health policy at email@example.com for any questions.
Avoid CMS Quality Initiative Payment Penalties (9/5/2012)
Navigate CMS Quality Initiatives like PQRS, Electronic Health Record Meaningful Use and E-Prescribing with the help of the Academy. We have a page dedicated to helping you meet all the requirements of these quality programs. To learn more about the programs, click here.
CMS Convenes Call with Physician Community to Discuss Development of Value Based Modifier (5/3/12)
In early March, CMS sent quality and resource use reports (QRURs) to nearly 24,000 physicians in Iowa, Kansas, Missouri, and Nebraska. These reports will be used in the development and application of the value based modifier required under the Affordable Care Act (ACA). A report template is available here.
In many practices, the email alerting physicians in these states to the availability of their QRUR will have gone to one physician or employee who has been designated as the point of contact for materials for their Medicare contractor (Wisconsin Physician Services (WPS)) that processes claims in the four states. Physicians can access their QRURs through that individual or by going here. The reports will be available until the first week of June 2012. Physicians with questions about specific data within their individual report are asked to email CMS_Medicare_Physician_Feedback_Program@mathematica-mpr.com.
In addition, WPS and CMS are soliciting feedback through a series of calls with physicians, practice administrators and physician representatives. A call will be held at 10 am CDT on Tuesday, May 8th. The Academy encourages you and your practice manager to participate. The telephone number is 1-800-665-9175. The conference ID is 3769368182.
Please contact the health policy department at firstname.lastname@example.org if you have received one of these reports or if you have any questions or comments.
CMS Issues Accountable Care Organization Final Rule- (10/25/11)
The Centers for Medicare and Medicaid Services issued their final rule for the Accountable Care Organization (ACO) Program. In the final rule, CMS addressed concerns the Academy presented in their written comments including reducing the number of quality measures and the elimination of the "two-sided risk" model from the Track 1 option that would have included shared savings and penalities. To see a chart outlining changes from the proposed rule to the final rule click here. To see the Academy's comments in June, click here.
MedPAC SGR Propsal
Medicare Payment Advisory Commission (MedPAC) Recommends Replacing SGR; Cutting Specialty Pay- (10/13/2011)
MedPAC voted to replace the Sustainable Growth Rate with new payment system that changes the current formulaic link between annual updates and cumulative expenditures for fee-schedule services and provide a stable ten year path for legislated fee-schedule updates without compromising beneficary access. The new recommended propsal has four parts which are
The Academy supports the repeal and replacement of the SGR, but does not support these proposals. The Academy signed onto a letter from the American Medical Association expressing this opposition.
CMS Restores Previous Supervision Requirements for Videostroboscopy & Nasopharyngoscopy
On July 18, 2011, the Centers for Medicare and Medicaid Services (CMS) officially notified the Academy that it had restored the previous supervision requirements (i.e. no supervision level assigned) for videostroboscopy (31579) and Nasopharyngoscopy (92511) when performed by speech language pathologists; in a March meeting with CMS, Academy representatives made it very clear that we support direct supervision. Learn more.
Academy Offers Feedback on the Proposed Rule for Accountable Care Organizations (ACO)
On June 6, 2011, the Academy sent a comment letter to the Centers for Medicare and Medicaid Services (CMS) providing input on the ACO proposed rule. In the letter, we highlighted the importance of specialists in promoting care coordination and stressed that the current ACO model proposed by CMS would be very challenging to implement. We encouraged CMS to adopt surgical measures specific to otolaryngology and also recommended that CMS provide a payment option that includes shared savings only without mandatory shared-loss provision.
Academy Advocates for Expanded National Coverage of Cochlear Implants for Sensorineural Hearing Loss - (May 26, 2011)
On May 11, 2011, Academy members - Jack Wazen MD, Debara Tucci MD, Craig Buchman MD, and staff attended a Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) meeting to provide data on the effectiveness of cochlear implants (CI) in patients and urge CMS to expand its coverage for the device. Although MEDCAC, which makes recommendations to CMS about its coverage for devices, concluded there was not enough evidence to expand Medicare coverage for CIs, it plans to continue engaging specialty societies and CI manufacturers so it can obtain more robust data on health outcomes.
NIA to Recognize ICACTL Accreditation of Advanced Imaging Services - (02/10/2011)
Due to our advocacy effort led by Gavin Setzen, MD, the National Imaging Associates (NIA) has agreed to recognize accreditation for advanced imaging from the Intersocietal Commission for the Accreditation of Computed Tomography Laboratories (ICACTL) from February 14, 2011. ICACTL is one of the three accreditation organizations that CMS has approved to certify advanced imaging services and is currently the only organization that accredits cone-beam CT scanners. View letter we sent to the NIA
New OTO-Tech and Audiology Billing Resources - (2/16/2012)
FAQs on Audiology- Provides clarification and guidance for proper billing of audiologic services.
Clarifying Medicare Audiology Billing Services: Audiology and OTO-Techs- answers questions on audiology billing and what services OTO-techs can bill.
The Academy is Advocating for You! - (07/29/2010)
FAQs on CMS’ Revisions to its Payment Policy for Consultation Services - (12/17/2009)
Electronic Health Records (EHR)
First Medicare Electronic Health Record (EHR) Incentive Payments Issued - (5/26/2011)
CMS Proposes New Exemption Categories under the Medicare E-Rx Program - (06/02/2011)
Summary of Workshop on Accountable Care Organizations (ACOs) - (11/2/2010)
CMS Issues Comparative Billing Reports on Advanced Diagnostic Imaging (3/1/2012)
For more informaiton on Comparative Billing Reports, see the Academy's Advanced Imaging webpage.
Advanced Imaging Accreditation
Academy Sends Comment Letter on ACR Appropriateness Criteria (4/21/2011)
Medicare Physician Fee Schedule
2011 MPFS Conversion Factor Update - (01/13/2011)
New Time Guidelines for Filing Medicare Claims - (11/1/2010)
Page Last Updated on May 3, 2012
Workshops held in cities nationwide will help otolaryngologists, their staff, and other healthcare professionals code correctly, learn risk reduction strategies, and organize business systems.