AAOS Advocacy in Action

AAOS Working to Improve Compromise Surprise Medical Billing Legislation

On December 17, AAOS wrote to congressional leadership advocating for improvements to the newly announced legislation to end surprise medical billing, which may be included in a year-end package and passed by Congress in the next several days. The “No Surprises Act” is the result of compromise negotiations between four committees and follows more than two years of AAOS advocacy to remove patients from the middle of out-of-network billing disputes. The legislation contains an independent dispute resolution (IDR) process in place of a federal rate-setting benchmark, as AAOS and other physician groups requested. Additional changes include the removal of a monetary threshold for access to IDR and the ability to batch claims to take to IDR AAOS continues to call for further improvements, including lessening the impact of a 90-day waiting period following IDR, improving the frequency of studies that will help us understand the ramifications of policy changes, and lessening the administrative burden. Read a summary of the legislation… 

AAOS Pushing Congress to Delay Medicare Cuts in Year-End Package

AAOS and a large coalition of healthcare organizations are urging Congress to pass critical legislation in any year-end package to halt pending Medicare payment cuts slated for implementation on January 1, 2021. The Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020 (H.R. 8702) is supported by nearly 400 medical organizations and 90 members of Congress, with companion legislation introduced in the Senate (S.5007) on December 10. There are only two opportunities remaining this year to delay the cuts with Congress having to either pass a spending bill or include a solution in a COVID-19 relief package. AAOS will continue to strongly advocate on behalf of orthopaedic surgeons to preserve the value of specialty care and protect patients’ access to musculoskeletal services. Contact your representatives on this issue… 

Healthcare Policy News

Congress Facing Deadline for Year-End Spending Package

With government funding set to expire Friday, Congress faces a firm deadline for passing the next large spending bill. Complicating matters during this year’s negotiations is the possibility of another COVID-19 stimulus package, which is considered essential for a second wave of the pandemic. Senate Majority Leader Mitch McConnell (R-KY) is requesting that liability protections for businesses be included in any subsequent relief, while Democrats are requesting additional funding for state and local governments. AAOS is closely monitoring these developments for several key items slated for inclusion in either the omnibus bill or the potential COVID-19 relief package. They include delays to the impending Medicare cuts to orthopaedic surgery and improvements to the newly released legislation to end surprise medical billing. The AAOS team will continue to work with lawmakers through the final moments of the congressional calendar to advocate for orthopaedic surgeons and their patients. Learn more about AAOS’ priority issues…

CMS Proposes New Rules to Address Prior Authorization

On December 10, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule focused on Improving Prior Authorization Processes and Promoting Patients’ Electronic Access to Health Information. The suggested changes relate to modifying the prior authorization processes and requirements of federal programs and are largely focused on streamlining and providing greater transparency around existing procedures. While the AAOS is encouraged to see attempts at alleviating burden for physicians, it would prefer that the misaligned processes and requirements be removed altogether. In general, prior authorization supersedes the training and experience of medical professionals and adds significant cost to the U.S. health care system. It can also negatively impact patient care and restrict the ability for innovation in health care delivery. The AAOS considers prior authorization to be a prominent issue for members and will be following closely to see if these proposals are finalized by the incoming Biden administration. Learn more about the proposed changes…

Revised 2021 E/M Changes are CPT Driven

In an effort to reduce administrative burden, the American Medical Association’s Current Procedural Terminology (AMA CPT) Editorial Panel worked with specialty societies and stakeholders to simplify and streamline documentation requirements for reporting office or outpatient evaluation and management (E/M) services (codes 99202-99215). Effective January 1, the significant changes to these code descriptors and guidelines remove the tallying of key components and allow providers to select E/M levels based on either medical decision-making or time. AAOS webinars address the changes in detail. The Centers for Medicare & Medicaid Services recently finalized a policy to adopt the revisions set forth in the 2021 CPT code set issued by the AMA CPT Editorial Panel. These revised CPT codes and guidelines affect all payers, not just Medicare. Since the CPT code set is the nation’s standard medical data code set, HIPAA requires that all health plans use the most recent version. Therefore, refer to the revised 2021 CPT code set for codes 99202-99215. Learn more about the upcoming E/M changes…

Applications Open for the Mark Frankle, MD, Health Care Policy Award

The American Shoulder and Elbow Surgeons (ASES), in partnership with the AAOS Orthopaedic Political Action Committee, is seeking applications for the Mark Frankle, MD, Health Care Policy Award, which provides selected ASES fellows unprecedented involvement in federal and state legislative policy. The goal of the award is to foster new leaders in advocacy, while advancing health care legislation and shoulder and elbow patient care. Each applicant must be an ASES resident fellow or candidate/associate member. Winners will receive a chance to spend up to 14 days at the AAOS Office of Government Relations in Washington, D.C.; $12,500 for fellowship expenses; an opportunity to present findings at the annual ASES meeting in October 2021 in Tampa; and exposure to health policy through Capitol Hill visits, and events such as the AAOS National Orthopaedic Leadership Conference in Washington, D.C. The deadline to submit an application is January 15, 2021. Apply for the health care policy award…

·        MICRA Will Be Tested Again in 2022 (AAOS Now, December)

·        My Experience with Advocacy During the In-District Event (AAOS Now, 12/9)

·        Surprise Billing Compromise Could Soon Pass Congress (MedPage Today, 12/16)

·        Doctors Build Bipartisan Support for Blocking Medicare Pay Cuts (Bloomberg Law, 12/9)