CMS Global Codes Affecting NJ

This is a reminder of the CMS rule that will impact NJ practices starting from July 1st. Below are two links that also talk about the G-Codes issue.

https://www.aaos.org/AAOSNow/2017/Jun/Managing/managing02/

Medicare Sharpens Focus on the Global Surgical Package
www.aaos.org

On Wednesday, November 2, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2017. CMS finalized a number of new PFS policies that will improve Medicare payment for those services provided by primary care physicians for patients with multiple chronic conditions, mental and behavioral health issues, and cognitive impairment conditions.

In the proposed rule, CMS recommended collection of post-operative data in three ways. The first prong would collect claims-based data on the number and level of visits in 10-minute increments from all physicians who perform Global Code (G-code) procedures. The second method would be a survey pf physicians and the third would be data collection from the accountable care organizations (ACOs). The claims-based universal data gathering proposal was deemed extremely burdensome on our surgeons and not in line with the intent of the Medicare Access and CHIP Reauthorization Act (MACRA) statute. AAOS commented to CMS explaining these issues as well as joined other surgical specialties in legislative and regulatory advocacy efforts to urge CMS to reverse this proposal.

Subsequently, in the final rule with comments [Regulation No. CMS-1656-FC] (available online at: https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-26515.pdf), CMS finalized three major flexibilities in reporting requirements as follows:

1.     CPT code 99024 can be used to collect data on the number of post-operative visits (as suggested by AAOS and others). Further, at this time, CMS will not require time units or modifiers to distinguish levels of visits to be reported.

2.     Instead of required reporting on all codes, CMS is just collecting data on the number of visits for codes that are reported annually by more than 100 practitioners and with high volume or high allowed charges (furnished more than 10,000 times or have allowed charges of more than $10 million annually as recommended by the RUC (AMA RVS Update Committee) and many other commenters including AAOS).

3.     Instead of collecting data from all physicians who perform global code procedures, CMS has finalized reporting requirements for a geographic sample of practitioners located only in the following states: Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon and Rhode Island.

Moreover, the start date for implementation of such data collection has been postponed from January 1, 2017 to July 1, 2017. At this time, CMS is not implementing the statutory provision that authorizes a 5 percent withhold of payment for the global services until claims are filed for the post-operative care, if required. The proposals regarding the physician survey and data collection in ACO has been finalized as proposed.

“CMS is hopeful that use of the existing CPT code for reporting these services will be significantly less burdensome than the proposal to require time-based reporting using the G-codes,” the agency wrote in a summary. “[W]hile practitioners are encouraged to begin reporting post-operative visits for procedures furnished on or after January 1, 2017, the requirement to report will be effective for services related to global procedures furnished on or after July 1, 2017. To the extent that these data result in proposals to revalue any global packages, that revaluation will be done through notice and comment rulemaking at a future time.”

Since reporting via the 99024 CPT code will only provide information on the number of visits, CMS will explore whether a survey would provide data on the level of visits (needed to value surgical services correctly) as mandated by the MACRA statute. AAOS will continue to monitor future rule making on this issue.

If you have any questions, please contact the AAOS.

ALERT: Opioid Emergency Regulations Adopted

NJOS Logo

Good afternoon:

The State Board of Medical Examiners yesterday, March 2nd, adopted emergency regulations to implement the new opioid prescribing limitations law recently signed into law by Governor Christie immediately. Please note that you and your physician colleagues should immediately comply with these regulations. Please find the emergency regulations here: http://www.njconsumeraffairs.gov/bme/Documents/BME-Emergency-Adoption-and-Concurrent-Proposal.pdf. In addition, please find an update to the bulletin we recently provided below. Again, the law’s prescribing requirements are now in effect. These emergency rules are effective immediately and will remain in effect for 60 days, and are being concurrently proposed for re-adoption to permit the submission of comments concerning the rules and the intention of the Attorney General and Board to make these rules permanent. Comments may be submitted after March 20th when this rule is officially published. We will remind you when that date approaches. contact us with any questions.

BULLETIN

NEW STATE OPIOID PRESCRIBING INFORMATION

Please review this entire bulletin and share it with your physician colleagues so they can comply with this new state law as soon as possible. Last month, Governor Chris Christie signed sweeping new legislation changing state law as to how and when opioid drugs may be prescribed. The law has now taken effect via emergency regulations. The bill was scheduled to take effect on May 16, 2017 but as we suspected the prescribing provisions are now in effect. Under the new law and according to the emergency regulations, a practitioner is not permitted to issue an initial prescription for an opioid drug in a quantity exceeding a five-day supply for treatment of acute pain. We advise members to amend their opioid prescribing practices to comply with the law as soon as possible.

Prior to issuing such an initial prescription, a practitioner shall:

Discuss with the patient the risks associated with the drug, including risks of addiction and overdose;
Explain the reasons why the prescription is necessary;
Set forth available alternative treatments;
Take and document the results of a thorough medical history;
Conduct, as appropriate, a physical examination;
Develop a treatment plan focused on the patient’s pain;
Access relevant information from the Prescription Monitoring Program.
On the fourth day of an initial prescription a practitioner may, after consultation with the patient, issue a subsequent prescription for the opioid drug. In order to do so, the practitioner must determine that the subsequent prescription is: (i) necessary and appropriate; and (ii) will not present an undue risk of abuse, addiction or diversion.

If a third prescription is issued to a patient for an opioid, the practitioner is required to enter into a pain management agreement with the patient. Finally, any health care professional authorized to prescribe an opioid shall take part in at least one educational credit (in each reporting period) related to prescribing opioid drugs.

Out-of-Network Update

On Monday, December 5th the Senate version of the Out-of-Network (OON) legislation, S-1285, was scheduled for a vote by the Senate Budget and Appropriations Committee. Over the course of the past weekend the New Jersey Hospital Association (NJHA) cut a last-minute deal with the OON bill sponsors. That deal would have called for amendments to the bill which would have proposed a cap on OON charges instead requiring an interim payment for OON services creating an option for binding arbitration only if the two parties could not come to an agreement. As soon as that deal was cut between the sponsors and NJHA other proponents of the bill including Horizon Blue Cross Blue Shield and major public employee unions expressed their opposition to this new proposal. As a result of those sudden changes and our continued opposition, Senator Vitale asked that the bill be removed from Monday’s Senate Committee agenda until a later date. A press conference announcing the NJHA deal was postponed. However, our Access to Care Coalition went forward with our press conference featuring bi-partisan legislators, physicians, and a patient to oppose this bill. Thank you to Dr. Monaghan for representing the Society at the press conference.

While we have slowed the advancement of OON we have not stopped it. We know that the sponsors will continue working on helping their supporters understand these changes so that the bill may move forward. This could happen as soon as December 15, 2016 or early next year. Your continued advocacy as a member of our society, in your practice, and in your hospital with your colleagues is very important. We continue to work within our Access to Care Coalition to strategize about next steps and raise questions and opposition to the bill. We will be in touch with new developments.

Regards,

AJ Sabath
NJOS Lobbyist