| AAOS News
Action Alert: Last Chance to Prevent Medicare Cuts
Finalized policies from the Centers for Medicare & Medicaid Services (CMS) are scheduled to cut Medicare payments to orthopaedics by approximately 5% and an additional 5% for hip and knee procedures. These anticipated changes will go into effect January 1, 2021 and are likely to destabilize health system financing and drastically diminish the opportunity for hospital and physician practices to recover financially from COVID. Fortunately, a high-impact piece of legislation has been introduced by Reps. Ami Bera, MD (D-CA-07), and Larry Bucshon, MD (R-IN-08), to provide a “relief payment” alleviating any Medicare reimbursement differences between 2020 and 2021/22. H.R. 8702, the Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020, would protect specialty healthcare professionals who are caring for our nation’s vulnerable Medicare population and preserve vital access to musculoskeletal services. The AAOS is asking members to reach out to their representatives and encourage them to cosponsor H.R. 8702. Take action by contacting your representative today…
Comments Submitted on Medicare Coverage of Innovative Technology
On November 2, the AAOS submitted comments on the Medicare Coverage of Innovative Technology (MCIT) and Definition of “Reasonable and Necessary” Proposed Rule. The Centers for Medicare & Medicaid Services (CMS) proposed the voluntary MCIT pathway to afford up to four years of national Medicare coverage to newly FDA market authorized breakthrough devices. The agency solicited feedback on numerous aspects of the MCIT pathway, including the time frame for coverage, opt-in/opt-out process for manufacturers, application of the National Coverage Analysis process, and indications for use. In its comments, the AAOS recommended that CMS grant four years coverage at a minimum and encouraged the agency to consider the impact of the COVID-19 pandemic on disrupting established coverage processes. The AAOS sees the MCIT pathway as a mechanism to spur innovation in orthopaedic devices and expressed strong support for its future application to drugs, diagnostics, and/or biologics subject to other expedited FDA approval processes beyond the Breakthrough Devices designation. Read AAOS’ full comments on the proposed rule…
Orthopaedic Societies Concerned With New Insurer Prior Authorization Policies
The AAOS along with several other musculoskeletal societies (ASES, AANA, AOFAS, AOSSM, and NASS) recently met with Anthem and AIM Specialty Health to discuss their shared opposition to new utilization management and prior authorization policies. These policies related to the AIM MSK program that has resulted in inaccurate medical necessity criteria, claim denials, and new prior authorization requirements. The group expressed concern over how the new policies and determinations would supersede physician autonomy, increase administrative burden, and negatively impact patient care. While some concessions were made, such as reassessing certain medical necessity criteria, Anthem and AIM Specialty Health reiterated their decision to ultimately move forward with their policy changes. The AAOS will continue to work with the relevant societies to address these issues. Read letters from the group… |
