Legislative, political, and health policy activity directly affects our practices and our patients. Read below to stay up-to-date on the current issues affecting our specialty.
The April edition of The ENT Advocate is now available online. This monthly e-newsletter offers an “insider” view into legislative and regulatory activity impacting the specialty, including the Academy’s key grassroots involvement opportunities.
On April 3, the Academy submitted a comment letter to Emblem Health opposing the company’s reimbursement policy to deny E/M services billed with modifier 25 within 28 days of a previous face-to-face service. The letter included a detailed CPT code analysis detailing the impact of this misguided policy on procedures commonly billed by the specialty.
Effective April 8, 2019, Highmark now considers eustachian tube balloon dilation medically necessary in adult individuals (22 years and older) when certain clinical criteria are met. This revised coverage policy applies to Highmark of Pennsylvania, Delaware, and West Virginia.
The Academy has prepared new member resources outlining the Top 100 Current Procedural Terminology (CPT) codes reported by providers with the subspecialty designation of “4-Otolaryngology” within the Medicare enrollment database. Two charts are now available: 2019 Top 100 ENT Codes Billed in a Physician Office and 2019 Top 100 ENT Codes Billed in the Hospital Outpatient Department. Further information and the chart files can be accessed as part of the Academy’s Coding Corner. The Coding Corner is a valuable resource available to AAO-HNS members that includes CPT for ENT articles, annual code change summaries, and ICD-10 coding resources.
Audiology Groups Announce Group Effort to Develop Direct Access Legislation
The Academy of Doctors of Audiology (ADA), the American Speech-Language Hearing Association (ASHA), and the American Academy of Audiology (AAA) recently announced a collaborative agreement to develop and advance federal legislation that would grant audiologists “direct access” to Medicare patients, eliminating the long-standing physician referral requirement. For patient safety reasons, the AAO-HNS has strongly opposed similar legislative proposals since hearing and balance disorders are medical conditions that require a full patient history, physical examination, and diagnosis by an MD/DO. The AAO-HNS anticipates the legislation will be formally introduced in the U.S. Congress in the coming weeks, so stay tuned for future updates and grassroots “Calls to Action.”
AAO-HNS Requests Federal Funding for Tobacco Control Efforts
The AAO-HNS joined others in the healthcare community in sending letters to U.S. Congressional appropriators regarding FY 2020 funding for the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention’s (CDC) Office on Smoking and Health (OSH). The FDA letter requests approval of $712 million in tobacco product user fees, the full amount authorized by the Tobacco Control Act. The CDC OSH letter asks for a $100 million increase in funding to help the agency better address the new epidemic of e-cigarette use among America’s youth.
FDA Advances New Policies Aimed at Reducing Youth Access to Flavored Tobacco Products
The FDA is proposing to strengthen its policies relating to flavored electronic nicotine delivery system (ENDS) products, such as electronic cigarettes (other than tobacco-, mint-, and menthol-flavored products), and prioritize enforcement of such products when offered for sale in ways that target minors. “Nobody wants to see children becoming addicted to nicotine. Our dedication to this effort will endure and our commitment to advancing our comprehensive framework will continue…We won’t tolerate a whole generation of kids becoming addicted to nicotine as a tradeoff for enabling adults to have unfettered access to these same unreviewed products, and we’ll continue to put the full scope of our regulatory tools against this mounting public health crisis.” Read the full statement from FDA Commissioner Scott Gottlieb, MD.
AAO-HNS Supports Congressional Resolution Recognizing World Hearing Day
The AAO-HNS joined others in the hearing health community to support a Congressional Resolution designating March 3 as World Hearing Day. The Resolution underscores the importance of hearing loss prevention, highlights the significance of patient access to early detection and intervention, and recognizes the role otolaryngologists serve on the hearing healthcare team. U.S. Representatives Mike Thompson (D-CA) and David McKinley (R-WV), Co-Chairs of the Congressional Hearing Health Caucus, introduced the Resolution on February 25.
Effective February 18, 2019, Highmark updated its commercial medical policies in Delaware, Pennsylvania, and West Virginia to cover stand-alone balloon ostial dilation of the sinus. The procedure is now considered medically necessary for the treatment of chronic sinusitis when specific criteria are met.
AAO-HNS Comments on ABMS Continuing Board Certification Vision Initiative
On January 14, the AAO-HNS submitted comments on the ABMS Vision Initiative’s Draft Report on Continuing Board Certification. While lifelong learning is essential, the AAO-HNS believes professional self-regulation through continuous learning and assessment must fit within the normal flow of a physician’s practice and be available at a reasonable expense. The letter highlights the Academy’s concerns with several of the Initiative’s recommendations, including the consolidation of ABMS oversight at the expense of individual specialty boards and the expectation that all diplomates participate annually in continuing certification programs.