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Practice Information

December 2020 updates

CMS

STARK LAW REVISION: The law prohibiting Medicare self-referral was passed in 1989. As CMS has begun to realize the role of value-based payments, they became keenly aware certain arrangements that were previously prohibited could lead to improved quality outcomes, improved health system efficiencies, and lower costs. Details of this new role will become increasingly clear over the next few weeks but it is hopeful that demonstrating quality, cost-effective care will finally be rewarded as opposed to punished.

As many of you are aware, First Coast Service Options, which is the Medicare carrier for Florida, has joined with Novitas under a single parent company.  It is expected that they will have similar if not identical coverage policies in the near future. New LCDs for FFR-CT and for non-invasive testing for stable ischemic heart disease are being developed. Although they’re developed by regional Medicare carriers, it is assumed that the chosen LCD will eventually serve as an NCD applicable to our patients with standard fee for service Medicare. A final coverage policy for FFR CT is being developed. The American College of Cardiology has recently submitted suggestions for expanding coverage.

Novitas is proposing an LCD on testing for stable ischemic heart disease. Cardiac PET is covered for perfusion but there is no specific mention of myocardial blood flow. FDG imaging for cardiac sarcoidosis is covered only if the patients are unable to carry out cardiac MRI. Serial testing in a stable asymptomatic patient is not considered appropriate for coverage. All stress modalities are considered equal. Therefore, it should clear the way for a clinician to choose the best test is for his/her patient. My concern is this may lead to test substitution. Again, our national ACC is very much involved in this.

First Coast is now requiring dual diagnosis for cardiac stress test time. This is leading to significant denials. Although most claims are paid on first or second appeal, it can take up to 120 days or more for payment. Obviously, this is unacceptable. National and state chapters and subspecialty organizations are all working on this together. For more information please review: https://medicare.fcso.com/Cardiology/0469513.asp.

PRIVATE PAYERS

United Health Care appears to be encouraging the use of coronary CTA and FFR-CT preferentially functional imaging (MPI, stress echo, stress CMR) in patients who are loaded intermediate risk they apply that most functional imaging will no longer be required in the future. There is significant industry support behind this initiative including an industry supported white paper that was published in JACC. The FCACC is working with national ACC to ensure the patient receives the right test at the right time when the physician completes the appropriate use criterion.

Humana has declared cardiac PET-CT an experimental procedure and is refusing coverage. All dedicated standalone PET cameras require CT attenuation and thus must carry out a CT scan for attenuation correction. This is clearly different from a hybrid diagnostic CT. Florida ACC is working with ASNC, SNMMI and national ACC in an attempt to resolve this critical reimbursement issue.

On the good news front BCBS of Florida is covering coronary CTA for intermediate preclinical risk ages 40-75. For details consult the following: http://mcgs.bcbsfl.com/MCG?activity=openSearchedDocMcg&imgId=75S7UABPY9FVM4CMREP

Local Coverage Determinations - HOW THE FL CHAPTER ACC GETS INVOLVED TO GET PATIENTS THE RIGHT CARE AT THE RIGHT TIME

Medicare uses a variety of mechanisms to set policies for coverage of services. At the national level, the Centers for Medicare and Medicaid Services (CMS) may issue a National Coverage Determination (NCD). Medicare administrative contractors (MAC) may issue Local Coverage Determinations (LCDs) or may choose to cover services or therapies on a case-by-case basis. If an NCD or LCD does not exist, it does not simply mean that Medicare will not pay for the service.

When national coverage has not been specified in NCD, MACs may choose to provide coverage for a service through an LCD. An LCD may be written in a manner that provides broad coverage, coverage with certain restrictions, or non-coverage. MACs develop LCDs through a process that is less formal than that used to develop an NCD. That process includes expert feedback from designated physician representatives. In Florida these include our CAC Representatives listed about who attend three formal meetings per year and consult with our carrier, First Coast Service Options.

Additional Tools for Practices
This tool provides current and draft local coverage determinations (LCDs), when they exist, for Medicare-covered procedure codes. Not every procedure code is covered by an LCD. For previous versions of an LCD, refer to the CMS Medicare coverage database. Click here for the tool.

Heart House has developed a network of CAC representatives from across the nation that meet as a group to review trends and analyze issues. The chair of the Third Party Reimbursement Committee is active at the national level through meetings and constant communication with colleagues.

National ACC has a web portal dedicated to practice issues. See this link for in-depth issues."Do Your PART" to Improve the Prior Authorization Process 

Payer-directed prior authorization for diagnostic imaging and medications is a tremendous barrier to patient care in today's cardiovascular care landscape. Help the ACC improve the prior authorization process by expanding the current data collection of inappropriate denials and difficult cases. ACC members and their staff are encouraged to submit instances of incorrect prior authorization denials for cardiac procedures and PCSK9 prescription through ACC's Prior Authorization Tool (PARTool) suite. Robust data collection is the first step to identifying and correcting exhaustive administrative burdens. Do your PART to improve the prior authorization.
Submit your data at ACC.org/PARTool today!

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FDA Announces Recall and Product Discontinuation of Boston Scientific LOTUS Edge™ Aortic Valve System

The FDA has announced a global, voluntary recall of all unused inventory of the Boston Scientific LOTUS Edge™ Aortic Valve System due to “complexities associated with the product delivery system.” No safety issues are of concern for patients who currently have an implanted LOTUS Edge valve. Read more

Importance of Proper Documentation: Provider Minute Video 

Why is proper documentation important to you and your patients? Find out how it affects items and services, claim payment and medical review in a new Provider Minute: The Importance of Proper Documentation video from CMS. Watch and learn about the top five documentation errors, how to submit documentation for a comprehensive error rate testing review, and how Medicare administrative contractors can help.

Getting a Flu Shot Saves Lives

As part of National Influenza Vaccination Week, your ACC has joined with the American College of Physicians to share information about the safety, effectiveness and ability of the flu vaccine to save lives. Learn more from the American College of Physicians here, and join the conversation on social media with #IRaiseTheRates#NIVW  and   #FightFlu. Looking for patient-centered resources about the flu shot, such as downloadable infographics and how the flu affects the heart? Check out ACC’s CardioSmart patient education tools here

Get the Latest CV Management and Leadership Strategies at CV Summit Virtual 

Join your ACC for the Cardiovascular Summit Virtual from Feb. 12 – 13, 2021. Master cardiovascular management and leadership strategies through focused sessions and workshops on hot topics ranging from physician reimbursement to navigating new coding changes included in the final Medicare Physician Fee Schedule. Also don’t miss the COVID-19 plenary session led by Anthony S. Fauci, MD. Early Bird registration ends Dec. 18. Don’t forget to take advantage of group discounts for practices and institutions

Deep Dive Into E/M Changes For 2021: Register For MedAxiom’s December Coding Bootcamp 

Several new coding changes, including Evaluation and Management (E/M) updates, will affect practices as soon as next month. Join MedAxiom next week for its December Coding Bootcamp, with sessions taking place daily from Dec. 14 – 17. Get details about the series and register individually for each session

Get the Latest CV Management and Leadership Strategies at CV Summit Virtual

Immerse yourself in an educational experience featuring the latest cardiovascular management and leadership strategies at Cardiovascular Summit Virtual – taking place Feb. 12 – 13, 2021. Gain access to engaging plenary sessions, including a session on “COVID-19: Public Health and Scientific Challenges” featuring Anthony S. Fauci, MD, as well as focused educational intensives on topics like physician compensation and telehealth. Also don’t miss small group workshops on topics ranging from site neutrality to finding the right practice. Access the agenda and register today.

Prepare for 2021! Register For MedAxiom’s December Coding Bootcamp

Join MedAxiom for its December Coding Bootcamp and prepare for 2021! Next year will introduce several coding changes, including Evaluation and Management updates, that will impact practices. The focused web series, with sessions taking place daily from Dec. 14 – 17, provides a unique opportunity to hear from experts about the latest in coding and set yourself up for success in 2021. Be sure to register individually for each session you wish to attend. Get details about the series.

Check Out HCM Guideline Tools

Your ACC has developed several tools to help clinicians and patients understand and use the new ACC/American Heart Association guideline for managing patients with hypertrophic cardiomyopathy (HCM). Learn more about the Guideline and access the clinician and patient tools, including a clinician-focused HCM Guidelines Made Simple Tool, a CardioSmart patient infographic and a JACC Genetic Testing Interactive Tool, on ACC’s HCM Guideline Hub

New Decade, New FDA Guidance For Diabetes Drug Development: Lessons Learned and Future Directions 

In March, the U.S. Food and Drug Administration (FDA) announced the decision to update their 2008 Guidance to Industry for diabetes drug development and released a draft for public comment based on numerous, rigorous cardiovascular outcome trials conducted since 2008. A new paper by Enrico G. Ferro, MD, et al., published in the Journal of the American College of Cardiology, explores the key events in this 12-year journey of drug development and compares the 2008 guidance with the proposed 2020 guidance. Read it here.

Guidance For Use of NCDR Clinical Quality Measures During COVID-19 Pandemic Released 

Your ACC has released guidance for the use of NCDR data for external accountability, such as health insurance payer programs or employment compensation programs. The new recommendations on patient outcomes and care process measures recognize the changes in health care delivery related to the COVID-19 pandemic, including hospitals suspending elective procedures and patients delaying or deferring medical care. The guidance is specific to NCDR clinical quality measures and is not intended to apply to all cardiovascular measures of quality care and outcomes, either those developed by the ACC or other organizations. Learn more.

Reminder: Check Your Email For RUC Surveys

You may have been randomly selected last week to complete a survey assessing the physician work for cardiac ablation services, endovascular repair of aortic coarctation, and percutaneous cerebral embolic protection. If you received a request, we encourage you to take a few minutes to complete the survey if you have not already done so. Your responses directly impact the recommendations made to the Relative Value Scale Update Committee, which affect the annual updates to the physician work relative values released in the Medicare Physician Fee Schedule. Access instructions for accurate survey completion and learn more through this video. Contact Claudia Vasquez at cvasquez@acc.org with any questions.

Estimate RVUs With Physician Fee Schedule Calculator

Work, practice expense and liability relative value units (RVUs) are updated annually through Medicare physician fee schedule rulemaking. ACC's new Physician Fee Schedule Calculator allows clinicians and practice managers to estimate the practice impact of changes included in the proposed 2021 Medicare Physician Fee Schedule and related addenda. Over time, the goal of the tool is to facilitate a thorough understanding of impacts from one year to the next. Download the tool.

CMS Launches New “Care Compare” Tool

The Centers for Medicare and Medicaid Services (CMS) on Sept. 3 launched the Care Compare tool, a streamlined redesign of eight existing health care compare tools previously available from CMS. The new tool allows patients and caregivers to extract a wealth of information about doctors, hospitals, nursing homes and other health care services, including cost, quality of care and volume of services. CMS has also made improvements to other agency data tools, including a price transparency tool and online decision support. Access the Care Compare website here.


Deep Dive Into Proposed Physician Fee Schedule QPP Policies

In response to the continued need for clinicians across the country to address COVID-19, CMS limited the number of significant changes to the Quality Payment Program (QPP) in the proposed 2021 Medicare Physician Fee Schedule. Among the highlights: CMS delayed the implementation timeline for the Merit-Based Incentive Payment System (MIPS) Value Pathways (MVPs) until the 2022 performance period. Additionally, the agency introduced an Alternative Payment Model (APM) Performance Pathway (APP) to align with the MVP framework. As part of APP implementation, the CMS web interface would be sunset as a collection type beginning in the 2021 performance period. Read more details


CardioSmart Debuts New Website For Patients, Clinicians

Your ACC’s new CardioSmart website is designed to emphasize the value of the patient and clinician partnership to personalize care. With the goal of better connecting patients with their clinicians to prevent or treat heart disease, the new CardioSmart.org provides information on heart conditions and trusted resources and tools to support important health conversations and foster strong partnerships. “Our new website is user-friendly, for both health care professionals and patients. Clinicians can refer patients, and patients can effortlessly find the information they need to aid in making key health decisions,” said Martha Gulati, MD, FACC, editor-in-chief of CardioSmart. “We continue to evolve and develop the resources our members want for our patients, be an up-to-date reliable source for everyone and improve the ease with which everyone can access information, whether from a clinic setting or at home.” Learn more

JACC Study: Cardiology Practices Consolidate in Response to Market Changes

Cardiologists are joining larger practices over time as health care markets change and emphasis on alternative payment models (APMs) increases, according to a study published July 27 in the Journal of the American College of Cardiology. Jose F. Figueroa, MD, MPH, et al., looked at whether cardiologists joined larger practices between 2013 and 2017 and at physician-level, community-level and supply-side factors associated with practice consolidation. The researchers found an association between higher market concentration and greater growth in practice size, suggesting “cardiologists may be responding to market-level forces.” “The rise of APMs, such as bundled payments and accountable care organizations … may be contributing,” they concluded. Read more

Understanding COVID-19 Testing For CV Specialists: Small Words With Big Pictures

With countries and states slowly reopening, questions and controversies around antibody testing and its effectiveness persist. Watch a Summer COVID-19 Education Session, “Understanding COVID-19 Testing For Cardiovascular Specialists: Small Words With Big Pictures,” led by Edward T. A. Fry, MD, FACC, with an expert panel of scientists, on demand to get an overview on serologic antibody testing, antibody tests and research articles. Also, be sure to read the latest document in Quick Tips on your ACC’s COVID-19 Hub, explaining how CMS and private payers have changed billing for telehealth/telemedicine/digital/remote services. 

Thinking Differently: Care Delivery and the Business of Medicine During COVID-19

By late March, MedAxiom's Impact of COVID-19 on Cardiovascular Organizations Survey found that more than half of respondents were performing less than 25% of their patient visits face-to-face. The pandemic proved that cardiovascular programs and practices can make enormous shifts in their access protocols, at lightning speed, but challenges remain. Read a new article in Cardiology magazine to learn more about operational changes and thinking differently when quick pivots are needed for care delivery. 

CMS Announces Ability to Opt Out of 2020 MIPS Program Due to PHE

This week, the Centers for Medicare and Medicaid Services (CMS) announced that physicians will have the option to opt-out completely or partially from the 2020 Merit-Based Incentive Payment System (MIPS) program by completing a hardship exemption application and indicating it is due to the COVID-19 public health emergency. Individual clinicians and group practices have until Dec. 31, 2020 to complete the hardship application. Learn more



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