Legislation

  AAOS Advocacy in Action Followed a federal judge’s decision to set aside key parts of the rule for implementing the No Surprises Act in one of six lawsuits challenging the major health care rule. Urged Congress to extend the current delay of 2% Medicare sequester payment reductions for the duration of the COVID-19 public health emergency, and to take action before April when sequestration is scheduled to resume. Expressed our support for the Resident Education Deferred Interest (REDI) Act, which [...]

News Ambulance Prior Authorization Model Expands April 1 Nutrition-related Health Conditions: Recommend Medicare Preventive Services Claims, Pricers, & Codes HCPCS Application Summaries & Coding Decisions: Drugs and Biologicals Events ICD-10 Coordination & Maintenance Committee Meeting — March 8–9 MLN Matters® Articles An Omnibus CR Covering: (1) Removal of Two National Coverage Determination (NCDs), (2) Updates to the Medical Nutrition Therapy (MNT) Policy, and (3) Updates to the Pulmonary Rehabilitation (PR), Cardiac Rehabilitation (CR), and Intensive Cardiac Rehabilitation (ICR) [...]

CMS Redesigns Accountable Care Organization Model to Provide Better Care for People with Traditional Medicare Global and Professional Direct Contracting Model Transitioning to ACO Realizing Equity, Access, and Community Health (REACH) Model Building on the Biden-Harris Administration’s priorities for a better health care system, today the Centers for Medicare & Medicaid Services (CMS) announced a redesigned Accountable Care Organization (ACO) model that better reflects the agency’s vision of creating a health system that achieves equitable outcomes through high [...]

News Podiatry Nail Debridement & Evaluation and Management Services: Comparative Billing Report Skilled Nursing Facilities: Submit Technical Expert Panel Nominations by March 16 Claims, Pricers, & Codes HCPCS Application Summaries & Coding Decisions: Non-Drug and Non-Biological Items and Services Skilled Nursing Facility Web Pricer ESRD: Web Pricer & Last PC Pricer MLN Matters® Articles CWF Editing – National Coverage Determination (NCD) 270.3 Blood-Derived Products for Chronic, Non-Healing Wounds International Classification of Diseases, 10th Revision (ICD-10) and Other Coding [...]

On February 11, the FDA authorized the emergency use of the monoclonal antibody bebtelovimab for the treatment of mild-to-moderate COVID-19 in adult and pediatric patients when all of these apply: They have a positive COVID-19 test result They’re at high-risk for progression to severe COVID-19 Alternative COVID-19 treatment options approved or authorized by the FDA aren’t accessible or clinically appropriate for them CMS created new codes, effective February 11: Q0222: Long descriptor: Injection, bebtelovimab, 175 mg Short descriptor: [...]

News CMS Expands Coverage of Lung Cancer Screening with Low Dose Computed Tomography There’s Still Time to Recommend the Flu Shot Compliance Surgical Dressings: Medicare Requirements MLN Matters® Articles Gap Billing Between Hospice Transfers April 2022 Update to the Medicare Severity – Diagnosis Related Group (MS-DRG) Grouper and Medicare Code Editor (MCE) Version 39.1 for the International Classification of Diseases, Tenth Revision (ICD-10) Diagnosis Codes for 2019 Novel Coronavirus (COVID-19) Vaccination Status and ICD-10 Procedure Coding System (PCS) [...]

News COVID-19: New HCPCS Code for Convalescent Plasma in Outpatient Setting Long-term Care Hospital Provider Preview Reports: Review Your Data by February 25 Inpatient Rehabilitation Facility Provider Preview Reports: Review Your Data by February 25 Skilled Nursing Facility Quality Reporting Program: January Refresh Nursing & Allied Health Medicare Advantage Payment - Revision to CY 2018 Help Address Heart Health Disparities Claims, Pricers, & Codes Inpatient Psychiatric Facility: Web Pricer & Last PC Pricer Events Transitional Coverage for Emerging [...]

  AAOS Advocacy in Action Raised concern over the process that edits are created and implemented in the Centers for Medicare and Medicaid Services' National Correct Coding Initiative, and proposed working with the agency to address issues in the future.       AAOS News Health Care Value Week Celebrates Progress, Charts Path Forward From Jan. 24-27, AAOS participated as a sponsoring organization in Health Care Value Week. The event was hosted by a diverse group of leading [...]

News COVID-19: Letter to Health Care Facility Administrators on Health Care Worker Vaccination Rule COVID-19 Vaccine & Monoclonal Antibody Products: Changes for Medicare Advantage Plan Claims Started January 1 — Reminder Compliance Home Health Low Utilization Payment Adjustment Threshold: Bill Correctly Claims, Pricers, & Codes SNF Consolidated Billing Codes for CY 2022 Events Provider Compliance Virtual Focus Group — February 24 MLN Matters® Articles Expedited Review Process for Hospital Inpatients in Original Medicare Internet-Only Manual Updates for Critical [...]

  AAOS Advocacy in Action Continued advocating against the improper implementation of the No Surprises Act by filing an amicus brief in support of an ongoing lawsuit against the federal government.       The Bone Beat New Episode Conversations on health policy issues affecting musculoskeletal care... Physician Advocacy for Patients with Insurers Insurer influence on the practice of orthopaedic surgery continues to increase. The implementation of the No Surprises Act on Jan. 1, along with the ongoing administrative [...]