Provider Relief Fund Reporting Portal is Now Open
The U.S. Department of Health and Human Services (HHS) announced that the Provider Relief Fund (PRF) Reporting Portal is now open for providers who need to report on the use of funds in Reporting Period 1. All recipients of PRF payments must comply with the reporting requirements described in the Terms and Conditions. Providers who are required to report during Reporting Period 1 have until Sept. 30 to submit their information. Reporting resources such as user guides, a data entry worksheet and frequently asked questions can be found on the PRF Reporting web page.
Senators Champion Funding for Military-Civilian Trauma Program
Fifteen U.S. senators championed a congressional sign-on letter to the U.S. Senate Appropriations Labor, Health and Human Services, Education and Related Agencies Subcommittee requesting $11.5 million in FY 2022 funding for the Military and Civilian Partnership for the Trauma Readiness Grant Program. Initially known as MISSION ZERO, this program was signed into law as a part of the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (P.L. 116-22). The program authorizes funding to ensure trauma care readiness by integrating military trauma care providers into civilian trauma centers.
As previously reported, Reps. Kathy Castor (R-Fla.) and Michael Burgess, MD, (R-Texas) championed a congressional sign-on letter to House appropriators. Additionally, the Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS) submitted statements to House and Senate appropriators urging funding.
Neurosurgery Joins Alliance in Supporting Medicare Patient Empowerment Act
On June 3, the CNS and the AANS joined the Alliance of Specialty Medicine in endorsing the Medicare Patient Empowerment Act (S. 826/H.R. 3322). In May, the neurosurgery groups sent letters of support to the bill’s sponsors — Sens. Rand Paul, MD, (R-Ky.) and Lisa Murkowski (R-Alaska) and Rep. Pete Sessions (R-Texas). This legislation would ensure that Medicare beneficiaries can seek care from the physician of their choice by allowing patients and providers to privately contract for Medicare-covered services without penalty. Under current law, Medicare beneficiaries that choose to see physicians who do not accept Medicare must pay the physician’s charge entirely out of personal funds. In addition, physicians who privately contract must opt-out of the Medicare program for two years.
Click here to read the Senate letter and here to read the letter to the House.
Neurosurgery Joins Alliance in Supporting COVID-19 Medical Liability Protection Legislation
On June 7, the CNS and the AANS joined the Alliance of Specialty Medicine in supporting H.R. 3021, the Coronavirus Provider Protection Act. Introduced in the House of Representatives by Reps. Lou Correa (D-Calif.) and Michael Burgess, MD, (R-Texas), this bipartisan legislation would safeguard medical professionals, and the facilities in which they practice, from COVID-19-related medical liability lawsuits.
Click here to read the letter.
Tell Your Representative about the Need for Prior Authorization Reform
To bring needed transparency and oversight to the Medicare Advantage (MA) program, the CNS and the AANS are urging Congress to adopt H.R. 3173, the Improving Seniors’ Timely Access to Care Act. If passed, this legislation would reduce prior authorization hassles and help curb unnecessary delays for patients covered by MA plans. Please contact Congress and ask your Representative to co-sponsor H.R. 3173.
Click here to go to neurosurgery’s Advocacy Action Center to send an email to your Representative asking them to co-sponsor the Improving Seniors’ Timely Access to Care Act. A sample message, which can be personalized, is provided.
Coding and Reimbursement
Medicare Requires Prior Authorization for Spine Procedures
Over the strenuous objection of the CNS, the AANS and other health care stakeholders, effective July 1, the Centers for Medicare & Medicaid Services (CMS) now requires prior authorization for cervical spinal fusion (CPT® codes 22551 and 22552) and implanted spinal neurostimulator procedures (CPT code 63650) when performed in the hospital outpatient department. Neurosurgeons may submit the prior authorization request to their Medicare Administrative Contractors (MACs) by mail, fax, CMS Electronic Submission of Medical Documentation or the MAC’s portal. The MAC must respond to the prior authorization request within 10 days. However, an expedited response may be granted within two days if the provider makes the case that a delay could jeopardize the beneficiary’s life, health or ability to regain maximum function.
More information is available as follows:
- Click herefor the program overview;
- Click here for detailed guidance from CMS;
- Click herefor answers to frequently asked questions; and
- Click hereto find your MAC for additional details about the new requirements.
Biden Administration Releases No Surprises Act Regulations
On July 1, the Biden Administration released “Requirements Related to Surprise Billing; Part I,” an interim final rule (IFR) that implements elements of the No Surprises Act (included as part of the Consolidated Appropriations Act, 2021) banning surprise medical bills. This rule:
- Bans surprise billing for emergency services — which must be treated as if they were provided on an in-network basis;
- Limits patient cost-sharing for out-of-network care at in-network provider rates;
- Bans out-of-network charges for ancillary care (e.g., anesthesiology & assistant surgeons) at in-network facilities; and
- Bans other out-of-network charges without advance notice.
The new rule also defines the methodology for determining the qualifying payment amount (QPA) — a key driver of provider payments for out-of-network care and patient cost-sharing amounts. The QPA is generally the health plan’s median in-network rate.
The CNS/AANS Washington Committee will review the IFR and submit comments to the Tri-Agencies (Departments of HHS, Labor and Treasury) overseeing the new law’s implementation.
The full press release with embedded links to fact sheets and the IFR can be accessed here.
UnitedHealthcare Scraps Emergency Care Coverage Rule
On June 10, UnitedHealthcare (UHC) announced it would delay implementing a new policy that would have retroactively denied coverage of emergency department visits. The policy was initially scheduled to take effect on July 1, but has been delayed until at least the end of the COVID-19 public health emergency. The CNS and the AANS joined a coalition effort led by the American College of Emergency Physicians objecting to this policy and urging UHC to rescind this policy permanently. Additionally, the neurosurgical groups joined the Alliance of Specialty Medicine in sending a similar letter.
Subsequently, as part of the No Surprises Act IFR, the Biden Administration will now outlaw policies that let insurers retroactively deny emergency department claims.
Graduate Medical Education
Neurosurgery Comments on Distribution of New GME Slots
On June 28, the CNS and the AANS joined a coalition letter led by the American Association of Medical Colleges to the CMS regarding the distribution of the 1,000 new GME slots provided in the Consolidated Appropriations Act, 2021 (P.L. 116-260). The letter urges CMS to distribute the new GME positions in a way that ensures teaching hospitals can make meaningful increases in residency programs to produce more physicians.
Click here to read the coalition letter.
Neurosurgery Urges CMS to Improve Quality Payment Program
As part of the effort to improve Medicare’s Quality Payment Program (QPP), the CNS and the AANS joined the Alliance of Specialty Medicine in sending a letter to CMS expressing concerns about physician-focused value-based care initiatives authorized under the Medicare Access and CHIP Reauthorization Act (P.L. 114-10). The agency has created disjointed, administratively burdensome and clinically irrelevant pathways that not only deviate from the intent of the original legislation but fall well short of the goals of genuine value-based care.
Click here to read the Alliance of Specialty Medicine letter.
2021 APM Incentive Payments Now Available
Eligible clinicians who were Qualifying Participants (QPs) in QPP Alternative Payment Models (APM) in 2019 will begin receiving their 2021 5% APM incentive payment this month. Neurosurgeons can now log in to the QPP website to determine if they are eligible for this incentive payment. The website will indicate the amount and the organization paid for both the 10-digit National Provider Identifier and the organization.
Neurosurgeons who believe they are eligible but did not receive payment may click here to download more information, including instructions for verifying Medicare billing information by Nov. 1. In addition, click here to download the 2021 Learning Resources for QP Status and APM Incentive Payment.
Drugs and Devices
2020 Open Payments Data Released
On June 29, CMS published the 2020 Open Payments program data and newly submitted and updated payment records for previous program years. The Open Payments program collects and publicly reports information annually about payments that pharmaceutical and device companies make to physicians and teaching hospitals for items such as travel, research, gifts, speaking fees and meals.
Click here to access the data.
Neurosurgeon Named Among Top 50 Clinical Executives
Donald M. Whiting, MD, FAANS, chief medical officer for the Allegheny Health Network (AHN), was selected as one of Modern Healthcare’s 50 Most Influential Clinical Executives. Each year, Modern Healthcare recognizes a select group of clinician executives who their peers and an expert panel deem to be the nation’s most influential leaders. Dr. Whiting created a consortium of regional health system chief medical officers to meet weekly during the pandemic and coordinate care and resource allocation. He also ensured that the health system focused on the needs of front-line workers, including the development of the Heroes Appreciation Program — a $5 million initiative to benefit roughly 12,000 workers in recognition of their work during the COVID-19 pandemic. Finally, Dr. Whiting held a key leadership role in AHN’s vaccination rollout, including large public events and stadiums in Pittsburgh.
Other health care leaders selected for this award included U.S. Surgeon General Vivek H. Murthy, MD; Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases; and Centers for Disease Control and Prevention Director Rochelle P. Walensky, MD.
Neurosurgeon Featured in Article about Medical Residents
As part of its coverage of the recent American Medical Association (AMA) House of Delegates meeting, a June 14 MedPage Today article titled “Medical Residents Need Better Working Conditions, AMA Delegates Say” featured Jason M. Schwalb, MD, FAANS. In the article, Dr. Schwalb, an AANS alternate delegate to the AMA, noted that “we need to attack the educational debt and not impose unfunded mandates on our residency programs... It’s just really not feasible without increased GME [graduate medical education] funding, and we think really the better way to go about this is by increasing student aid.” The delegates were discussing a resolution related to medical residents’ working conditions.
Neurosurgery Blog Launches Faces of Neurosurgery Interview Video Series
The Neurosurgery Blog: More than Just Brain Surgery recently launched a Faces of Neurosurgery interview video series. Conducted by Kurt A. Yaeger, MD, these neurosurgery luminaries are asked about their early mentors, proudest achievements and what advice they have for neurosurgical residents. To date, interviews with Kalmon D. Post, MD, FAANS (L) and R. Michael Scott, MD, FAANS (L) have been published.
Click here for Dr. Post’s interview and here for Dr. Scott’s interview.
Neurosurgery Blog Continues to Publish Women in Neurosurgery Series
2020 marked the historic 30th anniversary of the founding of Women in Neurosurgery (WINS). To celebrate, Neurosurgery Blog: More than Just Brain Surgery is publishing a series of articles highlighting the section’s goals — to educate, inspire and encourage women neurosurgeons to realize their professional and personal goals. WINS also serves women in neurosurgery by addressing the issues inherent to training and maintaining a diverse and balanced workforce is the mission of this section.
Neurosurgery Blog recently featured Catherine A. Miller, MD, and Doris Wang, MD, PhD, and the challenges of being a mother and a neurosurgeon in the guest blog post titled “Motherhood and Neurosurgery: How to Make it Work.” Along with Lola B. Chambless, MD, FAANS, and Lauren Albert Sand, MD, Drs. Miller and Wang participated in a webinar titled Motherhood & Neurosurgery. Hosted by the Department of Neurological Surgery at the University of California, San Francisco, the webinar offers candid reflections on pregnancy and starting a family as a neurosurgeon. Panelists share advice for working while pregnant or nursing and discuss how medical institutions can better support women surgeons through pregnancy and parenthood.
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Connect with the CNS/AANS Washington Committee and Washington Office on various social media platforms to keep up with the many health policy activities happening in the nation’s capital and beyond the Beltway.