Health Policy Update
The HPP Committee is working with the CCR (Coding, Coverage and Reimbursement) Committee of the AAOS to reconcile and improve the Global Service Data Book of the AAOS to make it a more powerful tool to correctly document coding bundling packages. Our goal is to have a product that our members can use to justify their coding practices with CMS and private payers to better adjudicate claims denials. The project is moving forward with work groups of the CCR Committee concentrating on various portions of the book. We plan to have the project finished for the 2010 edition of the book.
The RUC (RBRVS Update Committee) of the AMA was to have heard an application for PE (Practice Expense) values for diagnostic arthroscopy at its’ February meeting. We have been against this application at both the AANA and AAOS levels because of several patient safety, credentialing and reimbursement issues I outlined in the last newsletter. The application was voluntarily withdrawn just prior to the meeting so it seems this issue has been resolved for the time being.
The HPP committee will be working with representatives from the American Association of Hip and Knee Surgeons to submit applications for new hip arthroscopy codes for hip labral repair and treatment for FAI (Femoral Acetabular Impingement). The workgroup will contain several surgeons who have high volume hip arthroscopy practices. Because there are currently no level 1 CPT codes for these procedures, many AANA members are having problems getting reimbursed for hip arthroscopies. The plan is to have applications and survey data complete for submission for the RUC in February 1010.
The RUC 5 year Review process will be underway in August 2010. The review presents an opportunity for us to reassess the value of CPT codes that are undervalued, have changed significantly because of new technologies or present "rank order anomalies". A rank order anomaly is when a CPT code has a value that is inconsistent with other codes in a "family" of codes such as all knee arthroscopies. The RUC needs to alert CMS of the number of codes specialty societies will be bringing up for review. The HPP committee reviewed all the arthroscopic codes and will present the following codes for review: 29834, 29835, 29836, 29837, 29838, 29846 and 29847.
CMS has contracted with four National Recovery Audit Contractors (RACs) to review Medicare and Medicaid claims data from hospitals and doctors. The goal of the audits is to identify overpayments to providers and then claw-back these funds. The RACs are incentivized with a percentage of the overpayments returned to CMS. The process will start January 1, 2010 after the RACs have completed a national provider outreach program. The outreach will begin in June of 2009. I urge members to become familiar with this project and its’ potential impact on their practices. It is also important to understand what your rights and responsibilities are when contacted by one of the RACs for an audit. There is more information on the RACs at www.cms.hhs.gov/RAC/. As this issue represents considerable risk to its’ members, the AAOS is considering a service to contact for help and advice in dealing with the RACs. I will keep you informed about such a service when it becomes available.
There are funds available to physician through the 2009 $787 billion stimulus bill for "meaningful" users of EMR. A meaningful user is a provider that exchanges health information via EMR and reports quality indices electronically. The amount available is between $44,000-65,000 per doctor for the adoption and implementation of EMR. The method of payment of these funds has not been decided but should be in place by the summer of 2009. Most likely the payment will be made in the form of bonuses over a five year period between 2011-2016. There will be 1-3% penalties for those who are not "meaningful users" of EMR starting in 2015.
The bill also establishes the Federal Coordinating Council for Comparative Effectiveness that will be evaluating practice patterns and treatments for efficacy. The FCCCE will have 15 members, half of whom will be physicians or have "clinical expertise". The bill states that none of the Council recommendations should be construed as mandates regarding coverage or reimbursement but I have concern that such recommendations will eventually become mandates, especially in a "universal" system.
Health care reform legislation is the number one priority of the President and the Congress for the remainder of 2009. Reported plans are to have legislation for review by Memorial Day with passage slated for August. The House and Senate would then reconcile their respective versions to have a bill the President could sign by the end of 2009. We should all pay close attention to this process.