The AAO-HNS has a long history of working closely with regulatory agencies (e.g., Centers for Medicare & Medicaid Services, U.S. Food and Drug Administration) to maintain our visibility and credibility with national representatives regarding federal regulatory issues.
We believe that advocacy is the key to defining the future of otolaryngology. Federal regulatory advocacy is a top priority of the AAO-HNS.
CMS Releases Final FY2017 Medicare Fee Schedule
On November 2, the Centers for Medicare & Medicaid Services (CMS) released the 2017 Medicare Physician Fee Schedule final rule, which included key provisions relating to the collection and analysis of data for global surgical services.
In response to intense advocacy from the AAO-HNS and others in the Surgical Coalition, the final rule drastically reduces the expected reporting burden for surgeons by limiting the number of codes that require reporting, delaying the start date, designating only certain states for reporting, and excluding small practices.
The key changes in the final rule version of the global surgical services data collection and analysis provisions are:
- The reporting period begins July 1, 2017 instead of January 1, 2017.
- The reporting requirements are restricted to practitioners in practices with 10 or more practitioners in Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon, and Rhode Island rather than requiring all Medicare practitioners to report.
- Instead of a modifier, practitioners are required to report on claims data on post-operative visits furnished during the global period for the specified procedures using CPT code 99024.
- The specified procedures are procedures that are: a) furnished by over 100 practitioners and b) are either furnished more than 10,000 times annually or have annual charges that are greater than $10 million.
After a multifaceted regulatory and legislative advocacy campaign, the changes represent a substantial "win" for the surgical community. Learn more.
In addition to provisions regarding data for global surgical services, the rule includes finalized proposals for practice expense adjustments and Appropriate Use Criteria for Advanced Diagnostic Imaging requirements. The Academy is evaluating the final rule and will submit comments to CMS.
CMS Releases Final 2017 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment Rate
On November 1, CMS released the 2017 Hospital Outpatient Prospective Payment System (HOPPS) and Ambulatory Surgical Center (ASC) Payment Rate. The Academy is currently evaluating the final rule and will submit comments to CMS.
CMS Releases Post-SGR Payment Policy with MIPS and APM Final Rule
On October 14, CMS released the final rule, solidifying the details of the two new payment update tracks, the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). In the final rule, CMS adjusted several key aspects of the program the Academy submitted comments last spring. To learn more click here.
Health Policy Attends December MedPAC Meeting (1/13/2015)
As members know, the Medicare Payment Advisory Commission (MedPAC) is the independent commission charged with annually reviewing Medicare payment policies and making recommendations to Congress based on its review and findings. MEDPAC held meetings on December 18 and 19th to discuss preliminary draft recommendations to Congress that it will revisit in March when it drafts its annual report. Health Policy staff were in attendance and have summarized relevant topics discussed. Click here to view the summary.
March MedPAC Meeting (3/8/2014)
As members know, MedPAC is the independent commission charged with annually reviewing Medicare payment policies and making recommendations to Congress based on its review and findings. The Commission just recently released its annual report to Congress for 2014, a summary of which will be available to members shortly. In addition to its annual report, Medpac held meetings on March 6 & 7 where Health Policy staff were in attendance. Discussion at the March meetings focused on topics such as: Next Steps in Measuring Quality Across Medicare’s Delivery Systems and Developing Payment Policy to Promote Use of Services Based on Clinical Evidence.To view a summary of the March meeting, click here.
Payer Advocacy: 3P/BOG SEGR Joint Efforts
To better assist members with state and regional payer issues, the Academy’s Physician Payment Policy (3P) Workgroup is collaborating with Board of Governors (BOG) Socioeconomic Grassroots Committee Representatives to regionalize outreach and advocacy efforts. The new regionalization model was implemented January 1, 2014 in an effort to ensure members are represented on multiple levels, including addressing national, state, and local reimbursement issues. The regionalization plan divides the country into ten regions following the division used by the Department of Health and Human Services (DHHS), so that a regional representative from each region is charged with keeping the BOG up-to-date on Socioeconomic and Grassroots issues affecting that area of the country. This will be done primarily through regional reports at the fall and spring BOG meetings, conference calls and direct communication with the BOG Executive Committee. This new structure also requires that the BOG SEGR Regional representatives and leaders have an ongoing dialogue with the Academy’s Physician Payment Policy Workgroup (3P) leaders, whose primary focus and charge is to address national socioeconomic issues impacting the membership. It is the Academy’s hope that this new model will improve the flow of information at the various levels, as well as utilize Academy support resources more efficiently and effectively to better serve our members.
Communication Flow Chart
For an overview of how the 3P / BOG SEGR collaboration will work, view the Communication Flow Chart. This chart outlines the socioeconomic issues that will be tackled by the BOG at the local level, or by 3P and the Health Policy team at the national level.
Health Policy E-Care Package
To streamline communication between the two groups, and to support the BOG transition to a regional representative structure for Socioeconomic and grassroots issues, the Academy Health Policy team prepared a socioeconomic e-care package, which can be accessed here. This document outlines the wealth of practice management resources the Academy provides to members on our website. Resources include information related to common member inquiries such as: requests for coding clarification related to changes to CPT codes, national reimbursement rates, payer denials, transitioning to ICD-10 and more. These materials are intended to support the BOG SEGR representatives in responding to member’s local and state inquiries, as well as to assist members in furthering their relationships with payers and state OTO and medical societies in their regions and states.
FDA Issues Proposed Rule Deeming All Tobacco Products Subject to FDA Oversight including E-Cigs and Cigars (6/12/2014)
The Food and Drug Administration has issued a proposed rule that would “deem” any product meeting the statutory definition of “tobacco products” (Products that meet the statutory definition of “tobacco products” can include currently marketed products such as certain dissolvables, gels, hookah tobacco, electronic cigarettes, cigars, and pipe tobacco) to be subject to FDA's tobacco product authorities under chapter IX of the Federal Food, Drug, and Cosmetic Act (the FD&C Act). There is a second option to the proposed rule where the FDA would deem only a subset of cigars (i.e., to exclude from the scope of this proposed rule certain cigars that they refer to as “premium cigars”) as subject to FDA regulation. Click here to view a summary of the rule.
Academy members are encouraged to individually comment by visiting the user friendly page created by the Campaign for Tobacco Free Kids.
Submit Your Comments: HITPC Needs Physician Input on Your Experience with the EHR MU Incentive Program! (5/20/2014)
Health IT Policy Committee’s (HITPC) Meaningful Use Workgroup is seeking PHYSICIAN feedback on physician experience with Electronic Health Records (EHR) Meaningful Use (MU) Incentive Program to help inform recommendations for Stage 3 MU. As you may know, HITPC is the federal advisory committee that makes recommendations to the Secretary of Health and Human Services regarding EHR MU. While HITPC made recommendations to CMS about Stage 3 requirements this past April, on which the Academy submitted comments, HITPC is now asking for additional feedback. Specifically, HITPC’s Meaningful Use Workgroup wants feedback from physicians that have been using EHRs with feedback focusing on Clinical Decision Support (CDS), Patient Engagement, Care Coordination, and Population Management. Take advantage of this opportunity to influence policy by submitting comments. To ensure your voice is heard, members are encouraged to submit concise comments that offer constructive criticism with possible solutions and incorporate specific examples, if relevant. Submit your comments today by clicking here!
If Members would like to view the Academy’s recent comments on HITPC’s recommendations for Stage 3 to help inform their comments / recommendations to HITPC’s Meaningful Use Workgroup, click here.
Provider Enrollment Update
CMS has added a report containing the names of physicians with pending Provider Enrollment, Chain, and Ownership System (PECOS) applications. You may check this report to find out if your Medicare contractor is still processing your PECOS application. CMS plans to update this report twice a week. CMS has also provided enrollment guidance for physicians who infrequently receive payments from Medicare.
Provider Participation in the Medicare Program
Provides an overview of participation status options for providers in the Medicare program.
Internet Based Provider Enrollment, Chain and Enrollment System (Internet PECOS)
Provides a summary of the Internet PECOS
Internet Based PECOS-Getting Started
Provides instructions on creating or updating your enrollment record in PECOS.
Do you have an Enrollment Record in PECOS that contains your NPI?
Regarding Change Requests 6417 and 6421, CMS has made available a file that contains the National Provider Identifier (NPI) and the first and last names of all physicians and non-physician practitioners who are eligible to order and refer (in the Medicare program) and who have current enrollment records in Medicare (i.e., they have enrollment records in Internet-based Provider Enrollment, Chain and Ownership System (PECOS) that contain an NPI). You can check this file to ensure that you are enrolled in PECOS and enroll in PECOs if you aren’t.
Change in Provider Enrollment Timeliness Standards for Certain Paper Applications
Effective June 21, 2010 Medicare will change the timeliness standards for provider enrollment processing for the CMS-855I and 855B initial applications, change requests and reassignments.
The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA.
Viewing, Accessing or Maintaining your NPPES Account Information
CMS recommends that health care providers that have obtained their NPI know and maintain National Plan and Provider Enumeration System (NPPES) User Ids and passwords, reset NPPES passwords at least once a year and review NPPES records to ensure the accuracy of the information.
The NPI Registry enables you to search for a provider's NPPES information. All information produced by the NPI Registry is provided in accordance with the NPPES Data Dissemination Notice. You may run simple queries to retrieve this read-only data. For example, users may search for a provider by the NPI or Legal Business Name. There is no charge to use the NPI Registry.
Medicare Provider Enrollment forms, Provider Participation Application forms, Appeal forms, and Advance Beneficiary Notice Forms.
With the new MAC structure, there are 15 contractors by jurisdiction responsible for processing Part A and B claims. Four of the A/B MAC providers will overlap responsibility for handling Home Health and Hospice claims. The final four MAC plans will be the Durable Medical Equipment contractors.
A map illustrating the current Medicare Administrative Contrator Jurisdictions
Website links to your MACs. Obtain information on active LCDs and other billing and coding updates
Carrier Advisory Committee (CAC)
The CAC acts as a formal mechanism for physicians in the state to be informed about and to participate in the development of Local Coverage Determinations (LCD) in an advisory capacity, a mechanism to discuss and improve administrative policies
that are within carrier discretion and a forum for information exchange between carriers and physicians. To view a current list of ENT CACs. To obtain contact information for your CAC, contact the Health Policy team.
Academy Meets with CMS to Discuss MIPS and APMs (5/18/16)
On Wednesday, May 18, Academy staff met with CMS officials to discuss the proposed Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) programs. Members are currently scheduled to begin reporting for the MIPS and APM programs on January 1, 2017.
Academy staff and CMS officials discussed key policy topics including: the rapid implementation of the MIPS and APM programs with little time for preparation and necessary education; the complexity of the MIPS scoring system; Qualified Clinical Data Registry (QCDR) criteria and measures; and the restrictive Advanced APM definition that will preclude many specialists from qualifying for the new APM program. The Academy also requested that CMS offer educational and technical assistance for specialties societies and physicians to facilitate the shift from traditional Medicare reporting to reporting for the MIPS and APM programs.
The Academy also stated while the MIPS and APM programs are a positive step, CMS should continue to work with the Academy towards a system of payment innovation that would allow the greatest possible number of physicians to not only participate, but succeed. The Academy is currently working on formal comments for CMS. Once the comments are submitted to CMS comments will be made available to all Members.
Academy Comments on the MACRA RFI (12/22/15)
Using feedback solicited from key Academy leaders, the Academy has submitted comments on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Request for Information (RFI). The RFI primarily consists of questions concerning the implementation process for the new Merit-Based Incentive Payment System (MIPS) and eligible Alternative Payment Models (APMs). We anticipate that the newly created MIPS program will significantly impact otolaryngologists and will follow this matter closely. Read the comments.
Academy Comments on 2016 HOPPS Rule (12/22/15)
The Academy submitted comments on the final rule for CY 2016 Hospital Outpatient Prospective Payment System (HOPPS) and Ambulatory Surgical Center (ASC) Payment Rate. The Academy addressed: point-of-care imaging access for patients and changes to Ambulatory Payment Classifications assignments. Read the letter. Read the comments.
Academy Releases Summary of 2016 Medicare Physician Fee Schedule Final Rule (12/10/15)
The Academy has summarized key provisions of the 2016 Medicare Physician Fee Schedule final rule that affect otolaryngology including: practice expense changes; Global Surgical Package valuation; Physician Quality Reporting System and Qualified Clinical Data Registry requirements; Physician Compare; and Value Based Payment Modifier program. Read the summary.
Advocacy Update on CMS' Proposed Exclusion of Coverage of Osseointegrated Implants (11/3/14)
On October 31, the Centers for Medicare & Medicaid Services (CMS) released its final rule addressing the 2015 Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS) fee schedule. In the proposed version of this rule, CMS stated that the Medicare reimbursement exclusion for hearing aids would encompass all types of air conduction and bone conduction auditory prosthetics (external, internal, or implanted). After carefully reviewing comments and concerns from various groups including the Academy, CMS clarifies in its final rule that the statutory Medicare hearing aid coverage exclusion will not include certain auditory implants, including cochlear implants, brain stem implants, and osseointegrated implants. Therefore, CMS will be modifying § 411.15 in the final rule to reflect that Auditory Osseointegrated Implants (AOIs) will continue to be covered under Medicare and are outside the scope of the hearing aid coverage exclusion.
The Academy’s repeated advocacy was critical to helping CMS reach this conclusion. The Academy applauds this as a decision which will only yield a higher quality of care for the hearing health community! In addition, the Academy extends a warm thank you to all of the committee members and physician leaders involved in efforts to achieve this positive outcome!
While CMS will continue to exclude coverage non-osseointegrated devices (such as non-osseointegrated bone conduction hearing aids), CMS acknowledges the important technological advances that are occurring and leaves the door open for future consideration.
CMS published a proposed rule in July focusing on the 2015 Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS) fee schedule. Notably, part of the proposed rule specified that the Medicare reimbursement exclusion for hearing aids would encompass all types of air conduction and bone conduction auditory prosthetics (external, internal, or implanted). The rule essentially proposed to negate CMS' current coverage of osseointegrated implants. To view the proposed rule, click here.
In response to the proposed rule, Academy leadership and health policy staff advocated on multiple levels and engaged Academy committees, otolaryngology specialty societies, and other leaders among our membership (within Otology/Neurotology as well as health policy and government affairs) to craft comments that best represented our members and patients. More specifically, Academy leadership and staff conferenced individually and collectively with members and chairs of the Hearing and Implantable Hearing Devices Committees to gather specific examples and feedback on how the proposed rule, if enacted, would negatively impact thousands of patients who have no other recourse to better hearing. Further, the Academy participated in three direct meetings with CMS, various audiology and public interest group conferences, and meetings with presidents of the American Neurotology Society (ANS) and American Otological Society (AOS). All of these efforts were directed at raising awareness of the significant potential impact of this proposed rule and garnering support in defense of our position.
On September 2, 2014, the Academy, AOS, and ANS submitted a formal joint comment letter to CMS noting concerns about the proposal and providing a suggested alternative to the proposed rule that would allow for continued coverage of osseointegrated implants for Medicare patients. In addition, on September 3 the Academy met with Patrick Conway, MD, CMS Chief Medical Officer, Director, Center for Clinical Standards and Quality (CCSQ) and noted that our focus is on the patient and that as otolaryngologists, we are stewards of the patient’s health with the disagreement to the proposed change based on patient needs and outcomes, not personal or professional gain or concerns. We noted that while the comment letter is more focused on osseointegrated rather than non-osseintegrated bone conduction prostheses, there is a need for both. The focus on osseointegration does not mean that other types of prostheses should be excluded from coverage, just that they should be covered only when offered to patients with hearing loss due to medical/surgical conditions who cannot otherwise benefit from conventional hearing aids. The meeting went well with Dr. Conway asking Dr. Nielsen many specific questions related to our comments.
Subsequently, on October 31, CMS released its final rule and after careful consideration of comments received from various groups including the Academy, CMS clarified its definition of “hearing aid.” CMS will be revising its original proposal in the final rule to reflect that Auditory Osseointegrated Implants (AOIs) will continue to be covered by Medicare and are outside the scope of the hearing aid coverage exclusion.
Academy Comments on CY 2015 Medicare Physician Fee Schedule Proposed Rule (9/2/2014)
In July CMS released the proposed 2015 Medicare Physician Fee Schedule (MPFS) proposed rule. In its 2015 MPFS Proposed Rule, CMS proposed a new more transparent process for establishing PFS payment rates that will allow for more public input prior to finalizing rates. Under the new process, payment changes will go through notice and comment rulemaking before being adopted beginning for 2016. In addition, CMS is proposing changes to several quality reporting initiatives, changes to the Physician Compare Website and to continue phasing in of the Value Based Payment Modifier. Notably, CMS are also proposing to transform all 10- and 90-day global codes to 0-day global codes beginning in CY 2017, proposing to add roughly 80 codes to its list of potentially misvalued codes, and proposing adjustments to malpractice RVUs among other initiatives.
The Academy has reviewed and summarized the rule as a member benefit and has submitted formal comments on the rule by the September 2nd deadline. Click here to view the comment letter.
CMS Announces Release of Unprecedented Public Access to Data (4/8/2014)
Recently, the Centers for Medicare & Medicaid Services (CMS) stated it would allow public access to physicians’ Medicare Part B 2012 data, including access to the number and type of health care services, number of unique beneficiaries, average submitted charges, and average amount of money paid by Medicare for those services. While the Academy, along with other specialties, support the concept of transparency related to data, we cautioned that providers should have the opportunity to review their data prior to be in becoming public.
Coding Update: New CMS G-Code/Modifier Requirements for Therapy Services (3/13/2014)
Last year, CMS finalized several key changes to reporting requirements regarding therapy services. Specifically, CMS implemented a claims-based data collection strategy to collect data on patient function, which impacts key services provided by Otolaryngologists. CMS defines “therapists” as all practitioners who furnish outpatient therapy services. Under this policy, claims for therapy services must now include non-payable G-codes and modifiers, which will allow the agency to capture data on the beneficiary’s functional limitations at various points during the provision of therapy. For therapy services being furnished that are not intended to treat a functional limitation, the therapist should use the G-code for “other” and the modifier representing zero. For a full summary of the issue, click here.