Medicare
The Centers for Medicare & Medicaid Services (CMS) makes decisions regarding providers and patients on regulatory and reimbursement issues that impact all members of the Spine Intervention Society (SIS). The Health Policy Division actively monitors CMS coding, coverage, and reimbursement policy related to interventional pain management practice. SIS provides feedback to CMS on regulatory and reimbursement issues via comment letters and attendance at meetings.

MEDICARE NEWS & INFORMATION
CMS LETTERS
CMS EDUCATIONAL OFFERINGS
CONTRACTOR LINKS

MEDICARE NEWS & INFORMATION

MLN Connects™ National Provider Call: Transitioning to ICD-10

Wednesday, November 5; 1:30-3pm ET: Centers for Medicare & Medicaid Services (CMS) subject matter experts will discuss ICD-10 implementation issues, opportunities for testing, and resources. A question and answer session will follow the presentations.


CMS Releases ICD-10 Training and Preparation Webcast

CMS is offering a webcast with information on ICD -10 training and preparation, the second of a six-part series.


Check Your Data Before It Is Released to the Public (September 18, 2014)

The Physician Payment Sunshine Act (Open Payment) mandated the creation of a program to increase public awareness of financial relationships between drug and device manufacturers and health care providers. As a result, drug and medical device manufacturers will report annually payments and other transfers of value made to physicians.

Physicians can now review and dispute the information, which will eventually be released to the public, by September 8th


CMS Proposed 2016 Physician Payment Rule (July 15, 2015)

Earlier this month, the Centers for Medicare and Medicaid (CMS) released their proposed rule for the Medicare Physician Fee Schedule (MPFS) outlining payment and regulatory decisions for the year 2016. Society staff is currently reviewing the rule in detail and will prepare comments on issues of importance to our members. Additional information will be provided in future eNews.


Sunshine Act - Phase 1 Begins June 1 (May 22, 2014)

The Physician Payment Sunshine Act (Open Payment) mandated the creation of a program to increase public awareness of financial relationships between drug and device manufacturers and health care providers. As a result, and medical device manufacturers will report annually to CMS payments and other transfers of value made to physicians.

CMS will soon allow physicians to review Sunshine (Open Payments) disclosures from industry about transfers made to them.

Physicians who wish to review their data ahead of time in order to have the opportunity to dispute the information, need to complete a two-phase registration. Phase 1 (which begins on June 1st, 2014) consists of user registration for the CMS' Enterprise Portal. Phase 2 (which begins in July) consists of registration in the Open Payment System, allowing 45 days to review and potentially dispute disclosures, before the data is made public.

To obtain more information about the disclosures made under the Sunshine Act, please visit the CMS website HERE.

CMS LETTERS

SIS Joins with Other Medical Societies in Commenting on Proposed Rules Under MACRA
On June 27, 2016, the Spine Intervention Society submitted comments to the U.S. Centers for Medicare and Medicaid Services (CMS) on the proposed rule regarding the implementation of the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) under the Medicare Access and Chip Reauthorization Act (MACRA). SIS also joined numerous specialty and state medical societies in submitting two additional letters.
  
To see the SIS comment letter, click HERE.
To see the AMA-coordinated letter, click HERE.
To see the Multisociety letter, click
HERE.

SIS Submits Comments to CMS Regarding Proposed Decrease in PE RVUs (September 8, 2015)

The Spine Intervention Society submitted comments to the Centers for Medicare and Medicaid Services (CMS) on the Medicare physician fee schedule (PFS) proposed rule for CY 2016. The letter expressed concerns with the proposed direct practice expense (PE) relative value units (RVUs) for CPT codes 64633-64636, Destruction of Paravertebral Facet Joint Nerve. SIS believes that CMS is incorrectly interpreting and applying a stakeholder-provided invoice for radiofrequency generator equipment (supply code EQ214) that resulted in a substantial decrease in PE RVUs. We recommend that CMS revert back to the 2014 direct PE RVUs for this set of codes. To see the comment letter, click HERE.

International Spine Intervention Society Joins Medical Societies in Protesting Medicare Appeals Backlog (February 25, 2014)

The International Spine Intervention Society has joined numerous specialty and state medical societies in a letter the Department of Health and Human Services (HHS) Office of Medicare Hearings and Appeals (OMHA) expressing concern about the backlog of Medicare appeals. The letter urges OMHA "to develop a comprehensive solution to the Medicare backlog problem so that appealed cases may be assigned and adjudicated without delay.” The letter is available HERE.


Society Joins 600+ Physician Organizations in Urging Congress to Pass SGR Repeal (March 19, 2014)

The International Spine Intervention Society has joined over 600 physician organizations in letters to Senate and House of Representatives leadership that urges them to pass the legislation currently before both chambers of Congress to permanently repeal the “fatally flawed” sustainable growth rate (SGR) formula. The bipartisan legislation is a result of three key congressional committees and incorporates many recommendations from physician groups to reform the health care delivery and physician payment system. It also includes resources and tools to help physicians transition to new payment and delivery models. The letters are available here:

HR4015 S2000 Specialty Sign-on 2-21-14

HR4015 S2000 Specialty Sign-on Senate


International Spine Intervention Society, Pain Societies Call on CMS to Halt the Epidural Cuts (January 15, 2014)

The International Spine Intervention Society, along with multiple pain medical societies submitted a letter to Centers for Medicare and Medicaid Services (CMS) calling on CMS to halt the drastic cuts affecting interlaminar epidural procedures. The Society will be developing additional comments regarding the RUC and CMS valuation process and asking for a Refinement Panel review of these procedures. To view the letter click HERE.

Society members are encouraged to review the information that was circulated in last month's newsletter and submit comments to their legislators and CMS. For additional information please click HERE.

CMS EDUCATIONAL OFFERINGS

The CMS offers regular educational conference calls for Medicare providers and suppliers about new policies and changes to the Medicare program. To receive notification of upcoming calls, subscribe to the weekly MLN Connects Provider eNews. For more information, see the links below:

MLN ConnectsTM Provider eNews: http://www.cms.gov/Outreach-and-Education/Outreach/FFSProvPartProg/Provider-Partnership-Email-Archive.html .

MLN ConnectsTM National Provider Call Program: http://www.cms.gov/Outreach-and-Education/Outreach/NPC/index.html?redirect=/NPC/.

CONTRACTOR LINKS

The Medicare Administrative Contractors (MAC) process claims for Medicare beneficiaries. Contractors are responsible for specific geographic jurisdictions, as listed below. For more information, see: http://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/MedicareAdministrativeContractors.html.


CGS Administrators, LLC
- http://www.cgsmedicare.com/

  • MAC Jurisdiction DME C-Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia, Puerto Rico, U.S. Virgin Islands
  • MAC Jurisdiction 15-Kentucky, Ohio

National Government Services, Inc. (NGS) - http://www.ngsmedicare.com/ngs/portal/ngsmedicare

  • MAC Jurisdiction DME B - Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, Wisconsin
  • MAC Jurisdiction 6 - Illinois, Minnesota, Wisconsin
  • MAC Jurisdiction K - Connecticut, New York, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont

Noridian Healthcare Solutions, LLC - https://www.noridianmedicare.com/

  • MAC Jurisdiction DME D-Alaska, Arizona, California, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Oregon, South Dakota, Utah, Washington, Wyoming, American Samoa, Guam, Northern Mariana Islands
  • MAC Jurisdiction E-California, Hawaii, Nevada, American Samoa, Guam, Northern Mariana Islands
  • MAC Jurisdiction F-Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, Wyoming

Cahaba Government Benefit Administrators, LLC- http://www.cahabagba.com/

  • MAC Jurisdiction 10-Alabama, Georgia, Tennessee

First Coast Service Options, Inc.- http://medicare.fcso.com/

  • MAC Jurisdiction N-Florida, Puerto Rico, U.S. Virgin Islands

NHIC, Inc.- http://www.medicarenhic.com/

  • MAC Jurisdiction DME A-Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont

Novitas Solutions, Inc.- http://www.novitas-solutions.com

  • MAC Jurisdiction H-Arkansas, Colorado, New Mexico, Oklahoma, Texas, Louisiana, Mississippi
  • MAC Jurisdiction L-Delaware, District of Columbia, Maryland, New Jersey, Pennsylvania (includes Part B for counties of Arlington and Fairfax in Virginia and the city of Alexandria in Virginia)

Palmetto GBA, LLC- http://www.palmettogba.com/palmetto/palmetto.nsf/SiteHome?ReadForm

  • MAC Jurisdiction 11-North Carolina, South Carolina, Virginia, West Virginia (excludes Part B for the counties of Arlington and Fairfax in Virginia and the city of Alexandria in Virginia)

Wisconsin Physicians Service Insurance Corporation- http://www.wpsmedicare.com/index.shtml

  • MAC Jurisdiction 5-Iowa, Kansas, Missouri, Nebraska
  • MAC Jurisdiction 8-Indiana, Michigan

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