Orthopaedic News & Updates
February 2020
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How much time does your office spend completing prior authorizations? Orthopaedic surgeons across the country are voicing concern over the growing burden of prior authorization requests and the dangerous delays in care that they create for patients.
Prior authorization reform is needed now.
Bi-partisan legislation was recently introduced in the U.S. House of Representatives that aims to protect patients from the burden of prior authorizations. The Improving Seniors’ Timely Access to Care Act of 2019 (H.R. 3107) would reduce unnecessary delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program, and providing both oversight and transparency for health insurance.
Please join AAOS in urging your Representative to cosponsor this bill. Congress is likely to vote on prior authorization reforms this spring, so now is the time to make your voice heard.
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IMPORTANT MEDICARE UPDATES
Please Share with Staff
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The Medicare Carrier Advisory, National Government Services, recently conducted a conference call to review current Medicare topics, 2020 changes, operational updates and discussed the initial changes to Evaluation and Management billing which are planned for 2021.
Takeaways from Conference Call
Major Change – Appropriate Use Criteria for Advanced Imaging (including MRI). This year will be Educational (through 12/2020), full implementation is expected 1/2021.
When ordering advanced imaging for Medicare patient, physician will be required to consult a qualified Clinical Decision Support Mechanism (CDSM) which will provide the physician with a determination of whether the order adheres to the AUC. –
Please see complete details outlined in MLN document
.
- All Claims Must Use the New MBI number on Medicare Beneficiary Card
- Evaluation & Management Codes will change from 5 levels to 4 levels- Emphasized the importance of documentation of medical decision making and recording of time spent with patients. Changes are planned for 2021.
- Physician Assistants – In the absence of any state rules for physician supervision of PA services, CMS is finalizing a revision to the current supervision requirement to clarify that physician supervision is a process in which a PA has a working relationship with one or more physicians to supervise the delivery of their health care services.
- Cap on Amount of Therapy (PT and OT) per calendar year; $2080/each therapy mode. Once reached cap, care can continue as long as patient is progressing in goals outlined by referring MD. New OT and PT Modifiers.
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MOA 2020
Annual Meeting
Wednesday
April 29, 2020
Noon -6 p.m.
MA Medical Society
Waltham, MA
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- Location of all LCD data is now housed on CMS Medicare Coverage Database Site.
- LCD Reconsideration Process Revised (see slide 35 for process). All reconsideration requests must include the LCD# referencing; reason for reconsideration request; studies /evidence to support the reconsideration. Email requests to ngs.lcd.reconsideration@anthem.com.
MOA Requests Reconsideration of New Kyphoplasty LCD Policy
The MOA recently conferenced with the Medical Director from National Government Services, Medicare Advisory in Massachusetts, to request reconsideration of a recent Local Coverage Determination(LCD)Policy concerning Kyphoplasty, which now requires a multispecialty pathway to to treat Medicare patients. This multispecialty pathway includes a consensus by the referring physician, treating physician, radiologist and neurologist.
MOA Board member, Steven Leckie, MD brought the matter before the MOA Board and joined Dr. Walter Stanwood, MOA President, on the call the share his expertise on the subject matter and his concerns for Medicare patients.
The phone discussion with Craig Haug, MD, Medical Director, was productive and he noted that they would be reviewing the multispecialty pathway to modify the requirement. This process will take close to a year to complete and in the meantime, NGS has recommended that if a neurologist is not available in a practical timeframe, orthopaedic surgeons should document in the patient's medical record. In the event a claim is audited and denied solely on this basis, the documentation would increase the chance of a favorable outcome on appeal.
While the MOA recognizes that this is not ideal, MOA representatives were able to highlight the issues with the new policy and receive assurances from NGS and the Medical Director that this matter would be brought before the Carrier Advisory Committee for revisions. The MOA will inform its members when the review is scheduled.
A copy of the MOA letter can be found here for your reference.
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You won't want to miss the 2020 Annual Meeting offering clinical presentations, panel discussions, legislative and regulatory news with CME and Risk Management Credits.
The topics to be presented include:
- AI & Robotics Reshaping Orthopaedic Surgery -Pros/Cons
- Perioperative Management of Orthopaedic Patients with Addiction
- Safe & Reasonable Use of Stem Cells and OrthoBiologics in Sports Medicine and Early O.A.
- Orthopaedic Resident Paper Competition
- You Can Do It Too: Incubating an Orthopaedic Idea from Clinical Need to Commercial Product -A Moderated Panel Discussion
Plan to join your colleagues for an afternoon of educational updates, debates and discussion. The event will have CME and Risk Management credits for attendees.
Current members (2020) register for the low fee of $75.000. Not sure if you have renewed, contact Susan at the MOA, 860-690-1146 or email maorthoexec@gmail.com to check your status.
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MOA 2020
Membership Renewal
Support Advocacy & More
As the State House considers key bills impacting the profession and patients, the MOA is working diligently to support meaningful legislation to ensure the safety of patients with oversight of podiatrists by the BORIM, and seek fair out of network formularies and surprise billing policies the MOA remains vigilant to other health care reforms that may have a negative impact on orthopaedic surgeons, their practice and their patients.
Your 2020 membership is vital to the work of the MOA in supporting orthopaedic surgeons and defending the practice of medicine while protecting patients.
At just $300.00 a year (150.00 for first-year members), the MOA represents all orthopaedic surgeons whether you’re in private practice, hospital or academic based, you benefit.
Your membership renewal also includes a FREE
one-year
subscription to OrthoEvidence
- A global, online source for quality, evidence-based summaries by the orthopaedic community of the highest quality research at no cost to you ($100.00 value).
To Renew
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MOA Signs Onto AAOS Collective Comments to CMS Concerning Scope Expansion
The MOA was pleased to support the American Association of Orthopaedic Surgeons (AAOS) and all those represented by the orthopaedic state and specialty societies in response to the CMS request for comments concerning the President's Executive Order to expand the scope of practice for PAs and APRNs.
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