Bones of PA Latest News
Medicare to save $73.4B with surgery in ASCs through 2028: 5 things to know
Content provided by Becker's ASC Review
A new report from the Ambulatory Surgery Center Association shows performing surgery on Medicare patients in ASCs instead of hospital outpatient departments saved $4.2 billion in 2018, and the savings are expected to climb significantly in the next decade.
KNG Health Consulting conducted an analysis of Medicare payment data from 2011 to 2018 on outpatient surgical procedures in ASCs and hospital outpatient departments. The analysis estimated historical and potential savings with a focus on total knee replacements.
Five key points:
1. Medicare saved $28.7 billion from 2011 to 2018 from surgeries performed in ASCs instead of hospital outpatient departments. The report projects Medicare will save $73.4 billion from 2019 to 2028, with $12 billion saved in 2028 alone.
2. The percentage of total knee replacement and knee mosaicplasty is expected to grow from 13.4 percent of all procedures in ASCs in 2020 to 18 percent in 2028, a 3.7 percent annual growth. Based on that projection, ASC savings for Medicare total knee replacements would be $2.95 billion from 2020 to 2028.
3. Most of the savings in the last decade are attributed to high-volume procedures, including cataract surgeries and colonoscopies, but the report estimates procedures such as endocrine, cardiovascular and orthopedic surgery will drive most of the $73.4 billion savings through 2028.
4. The following five specialties are expected to save Medicare $1 billion per year by being performed in the ASC:
5. There are more than 5,800 Medicare-certified ASCs in the U.S., with the most common procedures today being cataract surgery, colonoscopy, upper GI endoscopies and pain management procedures.
Click here to read more.
Content provided by Becker's ASC Review
A new report from the Ambulatory Surgery Center Association shows performing surgery on Medicare patients in ASCs instead of hospital outpatient departments saved $4.2 billion in 2018, and the savings are expected to climb significantly in the next decade.
KNG Health Consulting conducted an analysis of Medicare payment data from 2011 to 2018 on outpatient surgical procedures in ASCs and hospital outpatient departments. The analysis estimated historical and potential savings with a focus on total knee replacements.
Five key points:
1. Medicare saved $28.7 billion from 2011 to 2018 from surgeries performed in ASCs instead of hospital outpatient departments. The report projects Medicare will save $73.4 billion from 2019 to 2028, with $12 billion saved in 2028 alone.
2. The percentage of total knee replacement and knee mosaicplasty is expected to grow from 13.4 percent of all procedures in ASCs in 2020 to 18 percent in 2028, a 3.7 percent annual growth. Based on that projection, ASC savings for Medicare total knee replacements would be $2.95 billion from 2020 to 2028.
3. Most of the savings in the last decade are attributed to high-volume procedures, including cataract surgeries and colonoscopies, but the report estimates procedures such as endocrine, cardiovascular and orthopedic surgery will drive most of the $73.4 billion savings through 2028.
4. The following five specialties are expected to save Medicare $1 billion per year by being performed in the ASC:
- Eye and ocular adnexa
- Cardiovascular
- Nervous system
- Digestive system surgery
- Musculoskeletal surgery
5. There are more than 5,800 Medicare-certified ASCs in the U.S., with the most common procedures today being cataract surgery, colonoscopy, upper GI endoscopies and pain management procedures.
Click here to read more.
Virtual Learning Dilemmas, Keeping Staff Socially Distanced Off-Hours, Enforcing Mask Policies, and Staying Sane in the Midst of a Global Pandemic
Content provided by: AAOE
Each month, AAOE is hosting an Ask Me Anything Series where attorneys and consultants answer your questions to help you stay on top of the ever-evolving COVID-19 climate. It’s a safe space where you can come together with your peers to get the information you need, hear what other practices are doing, and sometimes just connect with the only people who understand what you’re going through.
Below are the takeaways from the August 6 Ask Me Anything call.
How do you ensure staff are social distancing in their personal lives? What’s the line between protecting your patients and staff, and respecting their personal lives?
What can or should you do for staff whose children are required to do virtual learning and who have positions where they’re unable to work from home?
Click here to read the full article.
Content provided by: AAOE
Each month, AAOE is hosting an Ask Me Anything Series where attorneys and consultants answer your questions to help you stay on top of the ever-evolving COVID-19 climate. It’s a safe space where you can come together with your peers to get the information you need, hear what other practices are doing, and sometimes just connect with the only people who understand what you’re going through.
Below are the takeaways from the August 6 Ask Me Anything call.
How do you ensure staff are social distancing in their personal lives? What’s the line between protecting your patients and staff, and respecting their personal lives?
- Susan Childs, Founder of Evolution Healthcare, shared that her clients are struggling with staff who aren’t wearing masks or social distancing outside of the office. This poses an obvious risk to patients an other staff, but what can you legally require outside working hours?The rest of the panel advised against creating an unenforceable policy.
- Jeana Singleton, an attorney at Brennan, Manna, & Diamond, explained that staff education is your best plan of attack. She recommended continuing to educate your staff on your state’s mandates regarding masks and travel restrictions.
- Ryan Smith, an attorney at the Fredrikson & Byron law firm, echoed Singleton’s advice, stressing the importance of educating your staff about the guidelines in place to keep their coworkers and the practice’s patience safe. He added that your focus should be on what you can control: reducing the chance of transmission within the practice itself.
What can or should you do for staff whose children are required to do virtual learning and who have positions where they’re unable to work from home?
- This is a difficult and complicated issue, with no clear answer. Childs recommended sitting down one on one with staff who are affected to understand each of their individual needs, as a blanket policy likely won’t accommodate everyone. This is one more area that has caused uncertainty in our current environment, so the most important thing you can do is remain flexible and transparent with your employees.
Click here to read the full article.
2021 Medicare Physician Fee Schedule and Quality Payment Program Proposed Rule Summary
On August 4th, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule for the 2021 Medicare Physician Fee Schedule (PFS) and Quality Payment Program (QPP). Comments are due to CMS no later than October 5, 2020.
Click here to read the full summary.
CMS to Reimburse for Regenerative Orthopedic Product in ASCs
CMS updated the reimbursement calculation for Wright Medical's Augment regenerative solutions to allow for Medicare beneficiaries to undergo procedures with the product in ASCs and hospital outpatient departments.
Click here to read more.
CMS Delays Full Implementation of Appropriate Use – Again
As anticipated would happen by many in the industry, the Centers for Medicare & Medicaid Services (CMS) announced this week it is pushing back the mandate for referring providers to use appropriate use criteria (AUC) and clinical decision support (CDS) tools. Now, the testing period for physicians who order advanced imaging scans has been extended through the end of 2021.
Click here to read more.
Cuts Proposed to Surgical Services in 2021 Medicare Physician Fee Schedule
Last week, the Centers for Medicare & Medicaid Services (CMS) released the highly anticipated Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS) proposed rule. In the months prior to the release of the rule, AAOS had advocated against the proposed 5.4% cut to the work relative value units for hip and knee arthroplasty, as well as changes to the Evaluation and Management Office/Outpatient visit codes that were not extended to global surgical codes--which would lead to an overall 5% reduction to all orthopaedic surgical services. CMS has formally proposed these changes in the rule, and AAOS will continue to advocate against them through the rule’s comment period. Other changes proposed include making permanent some of the telehealth provisions implemented during the Covid-19 public health emergency, broadening the scope of practice for non-physician practitioners, pharmacists, and physical therapy assistants, as well as the introduction of the Alternative Payment Model Performance Pathway for the 2021 performance year. Members should be on the lookout for a grassroots opportunity soon to engage on this issue
Click here to read more.
On August 4th, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule for the 2021 Medicare Physician Fee Schedule (PFS) and Quality Payment Program (QPP). Comments are due to CMS no later than October 5, 2020.
Click here to read the full summary.
CMS to Reimburse for Regenerative Orthopedic Product in ASCs
CMS updated the reimbursement calculation for Wright Medical's Augment regenerative solutions to allow for Medicare beneficiaries to undergo procedures with the product in ASCs and hospital outpatient departments.
Click here to read more.
CMS Delays Full Implementation of Appropriate Use – Again
As anticipated would happen by many in the industry, the Centers for Medicare & Medicaid Services (CMS) announced this week it is pushing back the mandate for referring providers to use appropriate use criteria (AUC) and clinical decision support (CDS) tools. Now, the testing period for physicians who order advanced imaging scans has been extended through the end of 2021.
Click here to read more.
Cuts Proposed to Surgical Services in 2021 Medicare Physician Fee Schedule
Last week, the Centers for Medicare & Medicaid Services (CMS) released the highly anticipated Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS) proposed rule. In the months prior to the release of the rule, AAOS had advocated against the proposed 5.4% cut to the work relative value units for hip and knee arthroplasty, as well as changes to the Evaluation and Management Office/Outpatient visit codes that were not extended to global surgical codes--which would lead to an overall 5% reduction to all orthopaedic surgical services. CMS has formally proposed these changes in the rule, and AAOS will continue to advocate against them through the rule’s comment period. Other changes proposed include making permanent some of the telehealth provisions implemented during the Covid-19 public health emergency, broadening the scope of practice for non-physician practitioners, pharmacists, and physical therapy assistants, as well as the introduction of the Alternative Payment Model Performance Pathway for the 2021 performance year. Members should be on the lookout for a grassroots opportunity soon to engage on this issue
Click here to read more.
CMS releases new Advance Beneficiary Notice (ABN)
CMS just released the updated ABN CMS-R-131. The ABN should only be used for Medicare beneficiaries when a procedure or service might not be covered. The updated ABN goes into effect August 31, 2020 but you can begin using it now.
CMS added specific notifiers to the ABN instructions to include specific notifiers
Keep in mind if the procedure or service is never covered by Medicare obtaining the ABN is not required but is optional.
Do:
The updated ABN forms are available in PDF and Word format and are available in English and Spanish. There is also a separate ABN sample form for labs. The new forms along with the instructions can be found here. You should also reference CMS Publication 100-4, Chapter 30 of the Medicare Claims Processing manual which can be located here.
CMS just released the updated ABN CMS-R-131. The ABN should only be used for Medicare beneficiaries when a procedure or service might not be covered. The updated ABN goes into effect August 31, 2020 but you can begin using it now.
CMS added specific notifiers to the ABN instructions to include specific notifiers
- Physicians, providers (including institutional providers like outpatient hospitals), practitioners and suppliers paid under Part B (including independent laboratories);
- Hospice providers and religious non-medical health care institutions (RNHCIs) paid exclusively under Part A
- Home health agencies (HHAs) providing care under Part A or Part B
Keep in mind if the procedure or service is never covered by Medicare obtaining the ABN is not required but is optional.
Do:
- Understand the instructions and guidelines for completing and executing a valid ABN.
- Have the patient complete the form prior to obtaining the procedure or service.
- Allow the patient adequate time to review the ABN and understand the procedure or service recommended may not be paid by Medicare for the specific circumstance.
- Make sure the ABN is complete and the patient or patient’s representative signs the ABN
- Provide a copy of the signed ABN to the patient or representative.
- Always retain a copy in the beneficiary’s records.
- Have the patient sign an ABN when checking in for his/her appointment
- Have the patient sign a blanket ABN. A specific reason must be documented in Box E of the ABN form.
The updated ABN forms are available in PDF and Word format and are available in English and Spanish. There is also a separate ABN sample form for labs. The new forms along with the instructions can be found here. You should also reference CMS Publication 100-4, Chapter 30 of the Medicare Claims Processing manual which can be located here.
CMS proposes cutting Medicare payments for some specialty surgeries 6%-9%
Content provided by: Becker's ASC Review
CMS released its Medicare Physician Fee Schedule proposed rule for 2021 Aug. 3, which made several drastic cuts to payment rates for both general and specialty surgeons.
What you should know:
1. The rule would drop the conversion factor by $3.83 to $32.26. The current conversion factor is $36.09.
2. General surgeons will see their Medicare reimbursement rates cut by 7 percent under the proposed rule.
3. The following specialties will see the biggest impacts to their reimbursement rates:
5. The Surgical Care Coalition is lobbying Congress to waive Medicare's budget neutrality requirements for these E/M adjustments and increase all 10- and 90-day global code values.
6. In a recent survey conducted by the SCC, private surgical practitioners said the proposed rule would likely force surgeons to take fewer Medicare patients.
7. The rule also solidified the COVID-19-related temporary changes made to increase access to telehealth. The proposed rule would make those temporary changes permanent.
Read more here.
Content provided by: Becker's ASC Review
CMS released its Medicare Physician Fee Schedule proposed rule for 2021 Aug. 3, which made several drastic cuts to payment rates for both general and specialty surgeons.
What you should know:
1. The rule would drop the conversion factor by $3.83 to $32.26. The current conversion factor is $36.09.
2. General surgeons will see their Medicare reimbursement rates cut by 7 percent under the proposed rule.
3. The following specialties will see the biggest impacts to their reimbursement rates:
- Cardiovascular surgeons: 9 percent
- Thoracic surgeons: 8 percent
- Vascular surgeons: 7 percent
- Neurosurgeons: 7 percent
- Ophthalmologists: 6 percent
5. The Surgical Care Coalition is lobbying Congress to waive Medicare's budget neutrality requirements for these E/M adjustments and increase all 10- and 90-day global code values.
6. In a recent survey conducted by the SCC, private surgical practitioners said the proposed rule would likely force surgeons to take fewer Medicare patients.
7. The rule also solidified the COVID-19-related temporary changes made to increase access to telehealth. The proposed rule would make those temporary changes permanent.
Read more here.
State Hits Medicaid Plans for Contract Breaches
Content provided by: The News Service of Florida
Managed care plans were sanctioned 187 times and paid more than $2 million in damages during the 2019-2020 state fiscal year for breach of Medicaid contracts, according to information released by the state. The Florida Agency for Health Care Administration website shows that during the fiscal year, which ended June 30, 13 Medicaid managed-care health plans, one Medicaid specialty plan and three managed dental plans faced sanctions for failing to adhere to contract requirements. Staywell Health Plan, which has the largest market share in the state’s Medicaid managed-care system, had the most sanctions with 24 and the largest amount of liquidated damages with $668,150, according to the data, which was made publicly available Friday. Eight of the sanctions against the company stemmed from “provider services” violations, which included issues related to network adequacy, payment, credentialing and contracting and untimely or inaccurate reporting. For those eight violations, Staywell paid $261,750 in damages. Overall, provider services accounted for nearly one-third of the total number of sanctions during the fiscal year, with the state assessing $673,250 in liquidated damages against plans for 61 violations. In terms of dollars, though, state regulators assessed $732,050 in damages when managed care plans failed to follow contract requirements for covered services and authorizations. The state has contracts with 13 managed care companies to offer health services to poor, elderly and disabled people. The state also has contracts with five managed care plans to provide specialty services --- such as mental health services, care for people with HIV and AIDS and care for children with chronic medical conditions—and contracts with three managed dental-care companies.
Click here to read more. (News Service of Florida subscription required)
Content provided by: The News Service of Florida
Managed care plans were sanctioned 187 times and paid more than $2 million in damages during the 2019-2020 state fiscal year for breach of Medicaid contracts, according to information released by the state. The Florida Agency for Health Care Administration website shows that during the fiscal year, which ended June 30, 13 Medicaid managed-care health plans, one Medicaid specialty plan and three managed dental plans faced sanctions for failing to adhere to contract requirements. Staywell Health Plan, which has the largest market share in the state’s Medicaid managed-care system, had the most sanctions with 24 and the largest amount of liquidated damages with $668,150, according to the data, which was made publicly available Friday. Eight of the sanctions against the company stemmed from “provider services” violations, which included issues related to network adequacy, payment, credentialing and contracting and untimely or inaccurate reporting. For those eight violations, Staywell paid $261,750 in damages. Overall, provider services accounted for nearly one-third of the total number of sanctions during the fiscal year, with the state assessing $673,250 in liquidated damages against plans for 61 violations. In terms of dollars, though, state regulators assessed $732,050 in damages when managed care plans failed to follow contract requirements for covered services and authorizations. The state has contracts with 13 managed care companies to offer health services to poor, elderly and disabled people. The state also has contracts with five managed care plans to provide specialty services --- such as mental health services, care for people with HIV and AIDS and care for children with chronic medical conditions—and contracts with three managed dental-care companies.
Click here to read more. (News Service of Florida subscription required)
Administration considering ban on “surprise” medical bills
Politico (5/27, Luthi, Roubein) reports the administration is “floating a plan that would outlaw health care providers from putting patients on the hook for thousands of dollars in expenses” as part of “surprise” medical bills, but the plan has not mandated “how doctors and hospitals would recover their costs from insurers, according to administration officials, Capitol Hill aides and industry lobbyists familiar with discussions.” However, “powerful doctors groups,” such as the American Medical Association, are “wary of a policy that only bans the practice and doesn’t include a way to resolve payment disputes,” contending “the approach would leave health insurers with too much leverage.” AMA President Patrice A. Harris, M.D., M.A., said in a statement, “As there is no balance billing for COVID testing and treatment under most types of insurance, there is no need to rush these significant policy changes as part of the next COVID relief package.”
Politico (5/27, Luthi, Roubein) reports the administration is “floating a plan that would outlaw health care providers from putting patients on the hook for thousands of dollars in expenses” as part of “surprise” medical bills, but the plan has not mandated “how doctors and hospitals would recover their costs from insurers, according to administration officials, Capitol Hill aides and industry lobbyists familiar with discussions.” However, “powerful doctors groups,” such as the American Medical Association, are “wary of a policy that only bans the practice and doesn’t include a way to resolve payment disputes,” contending “the approach would leave health insurers with too much leverage.” AMA President Patrice A. Harris, M.D., M.A., said in a statement, “As there is no balance billing for COVID testing and treatment under most types of insurance, there is no need to rush these significant policy changes as part of the next COVID relief package.”
Strategic Alliance Provides a Wealth of Resources for Physician Practices
Cobbe Consulting & Management (CCM) and Acevedo Consulting Incorporated (ACI) today announced a strategic partnership to provide coding, compliance and regulatory training for our physician practices.
This partnership will make multiple programs available for our members that cover topics such as CPT, HCPCS, ICD-10-CM, third-party billing rules, reimbursement, as well as other services necessary to navigate the complex world of healthcare. Acevedo Consulting Incorporated specializes in coding, compliance, appeals, due diligence, HIPAA, education, physician and staff training, and more. All consultants at ACI are credentialed by the AAPC, Health Care Compliance Association and/or AHIMA.
The healthcare industry is ever evolving and so are the guidelines that practices must follow. Working in such a highly regulated industry requires strict adherence for regulatory compliance. Cobb Consulting is working to ease that burden for its members by providing access to a firm that specializes in compliance. The partnership between CCM and ACI helps ensure that physician practices have a trusted resource to help them navigate regulatory compliance.
“Acevedo Consulting Incorporated is known for their professional expertise and does phenomenal work for their clients. This partnership will help us better serve our members by giving them access to such a great firm,” said Fraser Cobbe, CEO of Cobbe Consulting & Management.
About Cobbe Consulting & Management
Cobbe Consulting & Management is an Association Management Company that specializes in representing medical associations across the country with a strong presence throughout the State of Florida. With over 20 years of experience in organized medicine, CCM represents some of the largest and historically significant organizations in the state including: Bones Society of Florida, Dade County Medical Association, Duval County Medical Society, Florida Orthopaedic Society, Florida Society of Nephrology, and the Physicians Society of Central Florida. CCM specializes in delivering unique programs and services and educational opportunities to the thousands of physicians and medical executives they represent in their family of organizations.
About Acevedo Consulting Incorporated:
Our consulting staff is nationally recognized for its expertise and our consultants are credentialed by the Health Care Compliance Association (HCCA), American Academy of Professional Coders (AAPC) and/or the American Health Information Management Association (AHIMA). The consultants’ 100+ years of combined and varied experience in the health care field are invaluable to the firm’s clients. Besides the requisite coding and compliance credentials and expertise, our consultants’ experiences range from serving in upper-level administrative and compliance positions for large hospital-based physician organizations and health plans. Members of our team are often lecturing at national organization and specialty society conferences, serving as an Investigative Consultant for the Department of Justice (DOJ) and as the IRO for organizations under a CIA. Acevedo Consulting often serves as an expert witness, renders opinions on expected fraudulent billing, assists with overpayment appeals, and conducts pre-acquisition and pre-employment Due Diligence.
Cobbe Consulting & Management (CCM) and Acevedo Consulting Incorporated (ACI) today announced a strategic partnership to provide coding, compliance and regulatory training for our physician practices.
This partnership will make multiple programs available for our members that cover topics such as CPT, HCPCS, ICD-10-CM, third-party billing rules, reimbursement, as well as other services necessary to navigate the complex world of healthcare. Acevedo Consulting Incorporated specializes in coding, compliance, appeals, due diligence, HIPAA, education, physician and staff training, and more. All consultants at ACI are credentialed by the AAPC, Health Care Compliance Association and/or AHIMA.
The healthcare industry is ever evolving and so are the guidelines that practices must follow. Working in such a highly regulated industry requires strict adherence for regulatory compliance. Cobb Consulting is working to ease that burden for its members by providing access to a firm that specializes in compliance. The partnership between CCM and ACI helps ensure that physician practices have a trusted resource to help them navigate regulatory compliance.
“Acevedo Consulting Incorporated is known for their professional expertise and does phenomenal work for their clients. This partnership will help us better serve our members by giving them access to such a great firm,” said Fraser Cobbe, CEO of Cobbe Consulting & Management.
About Cobbe Consulting & Management
Cobbe Consulting & Management is an Association Management Company that specializes in representing medical associations across the country with a strong presence throughout the State of Florida. With over 20 years of experience in organized medicine, CCM represents some of the largest and historically significant organizations in the state including: Bones Society of Florida, Dade County Medical Association, Duval County Medical Society, Florida Orthopaedic Society, Florida Society of Nephrology, and the Physicians Society of Central Florida. CCM specializes in delivering unique programs and services and educational opportunities to the thousands of physicians and medical executives they represent in their family of organizations.
About Acevedo Consulting Incorporated:
Our consulting staff is nationally recognized for its expertise and our consultants are credentialed by the Health Care Compliance Association (HCCA), American Academy of Professional Coders (AAPC) and/or the American Health Information Management Association (AHIMA). The consultants’ 100+ years of combined and varied experience in the health care field are invaluable to the firm’s clients. Besides the requisite coding and compliance credentials and expertise, our consultants’ experiences range from serving in upper-level administrative and compliance positions for large hospital-based physician organizations and health plans. Members of our team are often lecturing at national organization and specialty society conferences, serving as an Investigative Consultant for the Department of Justice (DOJ) and as the IRO for organizations under a CIA. Acevedo Consulting often serves as an expert witness, renders opinions on expected fraudulent billing, assists with overpayment appeals, and conducts pre-acquisition and pre-employment Due Diligence.
