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Modest Changes in Echo Professional Fees But Significant Changes in Hospital Outpatient Echo Payment Proposed by Medicare for 2016 (7/10/15)

The Centers for Medicare and Medicaid Services (CMS) recently released proposed changes to the Medicare allowances for physicians’ services paid under the Physician Fee Schedule (PFS) and services provided by hospital outpatient departments paid under the Hospital Outpatient Prospective Payment System (HOPPS). If the changes are adopted as proposed, the amounts paid for physicians services (Professional and Technical Components) under the PFS would remain relatively unchanged in 2016, but hospitals would experience significant changes in the amounts paid by Medicare for the overhead, supplies, equipment, and non-physician personnel costs associated with outpatient echos. Read more here.

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CMS Medicare Physician Payment Schedule Proposed Rule Released

The Centers for Medicare and Medicaid Services (CMS) released the 2016 Medicare Physician Payment Schedule Proposed Rule proposed rule. View it here.

The CMS Fact Sheet can be found here.  ASE is analyzing these recommendations and will share a more detailed and targeted analysis soon.

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CMS and AMA announce efforts to help get ready for ICD-10

The American Medical Association and CMS jointly announced that an agreement has been reached on important elements of a “grace period” for the October 1, 2015, implementation of the ICD-10 diagnosis code set.

In guidance that is being transmitted, CMS announced that:

  • For a one year period starting October 1, Medicare claims will not be denied solely on the specificity of the ICD-10 diagnosis codes provided, as long as the physician submitted an ICD-10 code from an appropriate family of codes. In addition, Medicare claims will not be audited based on the specificity of the diagnosis codes as long as they are from the appropriate family of codes. This policy will be followed by Medicare Administrative Contractors and Recovery Audit Contractors.
  • To avoid potential problems with mid-year coding changes in CMS quality programs (PQRS, VBM and MU) for the 2015 reporting year, physicians using the appropriate family of diagnosis codes will not be penalized if CMS experiences difficulties in accurately calculating quality scores (i.e., for PQRS, VBM, or Meaningful Use). CMS will continue to monitor implementation and adjust the duration if needed.
  • CMS will establish an ICD-10 Ombudsman to help receive and triage physician and provider problems that need to be resolved during the transition.
  • CMS will authorize advanced payments if Medicare contractors are unable to process claims within established time limits due to problems with ICD-10 implementation.

The October 1 deadline for implementation of the ICD-10 code set is fast approaching, and time is running out for physician practices to complete their preparation. The AMA has a broad range of materials available on its web site to help physicians prepare for the October 1 deadline. For additional information please visit here.

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CMS releases the proposed HOPPS rule

The Centers for Medicare and Medicaid Services (CMS) released the proposed rule to the Hospital Outpatient Prospective and Ambulatory Surgical Center Payment Systems.The proposed rule also includes important proposed changes to the Two Midnight Rule for CY 2016. See this related fact sheet for detailed information on this rule and click here to view the full detailed fact sheet on CMS changes. ASE is analyzing these recommendations and will share a more detailed and targeted analysis soon.

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Special report on Summit 2014 in this month’s JASE

Last fall the ASE Foundation (ASEF) gathered leaders from across the healthcare spectrum in the nation’s capital to offer a variety of unique perspectives on the transition to value-based healthcare, with a focus on the role of cardiovascular ultrasound in the changing environment. The summary report from this first-of-its-kind event has now been published in the July issue of JASE, and will serve as an excellent resource for our members to demonstrate the value of echocardiography to colleagues, administrators, and others in the healthcare community.

In addition, ASEF has added speaker slides and video summaries of two panels to the Summit 2014 website, and will continue to add additional videos and other resources as often as possible.  One of the highlights of the program featured a panel session with three patients whose care was directly impacted by the use of echocardiography. Click here to watch Sarah Woodruff, an adult with congenital heart disease, talk about the value that echo has brought to her life.

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Submit Images for ASE’s 2016 Calendar

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New Category III codes announced July 1, 2015

On July 1, 2015 the American Medical Association (AMA) released its semi-annual update to its list of CPT Category III codes. The AMA identified 34 new Category III codes; these codes all are scheduled to become effective as of January 1, 2016.  Of particular interest to Echocardiographers is 0399T – Myocardial strain imaging as described below:

  • 0399T: Myocardial strain imaging (quantitative assessment of myocardial mechanics using image-based analysis of local myocardial dynamics)
    ►(Use 0399T in conjunction with 93303, 93304, 93306, 93307, 93308, 93312, 93314, 93315, 93317, 93350, 93351, 93355)◄
    ►(Report 0399T once per session)◄

Reminders for your practice

  1. Typically Category III codes replace unlisted codes that were previously used for new procedures or services.   Prepare to update your charge sheets.
  2. If a Category III code describes the procedure or service performed, it must be reported. An unlisted code or less specific Category I cannot be reported in place of an active Category III code.
  3. Reimbursement of Category III codes is at the discretion of payers.  During the six months between announcement of new Category III code and active date, practices interested in utilizing new code should begin working with local payers to obtain coverage and payment.
  4. Category III codes are released on a semi-annual basis in January and July and are published on the AMA’s website.  Please reference the AMA website for a complete listing of all recently approved Category III codes

Also, with the passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACA) Congress permanently repealed and replaced the Sustainable Growth Rate Formula and a providing to increase the Medicare conversation faction by .05%. This increase will go into effect today, July 1.

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Echocardiography in Hypertension

ECHOCARDIOGRAPHY IN HYPERTENSION — PROVIDING THE FULL PICTURE TO IMPROVE PATIENT CARE. Read release here.

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Claim CME from ASE 2015

Learn how to claim your CME from ASE 2015 here.

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