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This week’s headlines:
Congressional action

Congress agrees to 12-month reprieve from flawed Medicare payment formula
As part of a larger package to avert the impact of the “fiscal cliff”, Congress approved a one-year reprieve from the 26.5 percent Medicare physician payment cut that was scheduled to begin Jan. 1, 2013, due to the flawed Sustainable Growth Rate (SGR) formula. Congress did not make any changes to the practice expense and work relative values that were implemented in the 2013 Medicare Physician Fee Schedule (see related items below).

Additionally, Congress agreed to defer the 2 percent across-the-board sequestration cuts to government programs, including Medicare, for two months. The delay means that if Congress does not act prior to March 1, a 2 percent cut in Medicare payments will take effect, along with cuts to other programs.

American Academy of Dermatology Association (AADA) President Daniel M. Siegel, MD, reiterated the organization’s commitment to finding a permanent solution to the SGR formula issue, and urged Congress to immediately address this problem by enacting a long-term solution. The AADA will continue to push for a permanent fix to Medicare’s physician payment system that protects Medicare patients, pays physicians fairly, and improves quality and efficiency.

Contact AADA government affairs staff with any comments or questions regarding the SGR fix at govtaffairs@aad.org.

Federal agency focus

AADA comments on the 2013 Physician Fee Schedule final rule
On Dec. 31, the American Academy of Dermatology Association (AADA) submitted a letter of comment to the Centers for Medicare and Medicaid Services (CMS) in response to requirements outlined in the 2013 Physician Fee Schedule final rule.

The AADA acknowledged that CMS accepted the majority of the AMA’s Specialty Society Relative Value Scale Update Committee (RUC) recommendations on approximately 30 dermatology codes that were surveyed in 2012, but expressed concern that CMS did not accept several critical RUC recommendations and altered them without giving adequate reason or rationale. Specifically, the AADA opposed CMS’s reductions in relative value units (RVU) —particularly practice expenses—that were in excess of the RUC recommendations. The likelihood of a reversal of those additional cuts are unknown.

The final 2013 Fee Schedule included a significant reduction in reimbursement for the technical component (TC) of surgical pathology code 88305. Values recommended by the RUC after a fair and impartial examination of true costs would have resulted in a decrease. However, that code’s TC was cut in excess of RUC recommendations at 52 percent, although the professional component (PC) was raised by 2 percent. Overall, the global value of 88305 was reduced by 33 percent.

Additionally, the Fee Schedule included a reduction to complex repair code 13152 by 13 percent, and complex repair code 13132 by 16 percent — which were mostly due to a cut in physician work RVUs. For 13152, the physician work RVU was cut 23.08 percent; the practice expense RVU was cut 4.4 percent. For 13132, the physician work RVU was cut 27.36 percent; the practice expense RVU was cut 7.59 percent. View the effect of the 2013 Physician Fee Schedule final rule on key dermatology codes.

A fundamental priority for AADA advocacy is to ensure the fair and accurate valuation of dermatologic services. Throughout the year, the AADA has actively weighed in on this rulemaking process with regard to important provisions affecting physician payments. Read the AADA comment letter on the 2013 Medicare Physician Fee Schedule final rule. Read the full text of the final rule here.

CMS revises fee schedule to reflect SGR fix; no changes to practice expenses, work relative values
The Centers for Medicare and Medicaid Services (CMS) has revised the 2013 Medicare Physician Fee Schedule to reflect the recent congressional agreement on a one-year reprieve from the 26.5 percent physician Medicare payment cut that was scheduled to begin on Jan. 1, 2013, due to the flawed Sustainable Growth Rate (SGR) formula. The revisions include technical corrections that were identified after the final rule was published in November. The 2013 conversion factor is $34.0230.

Although Congress agreed to a one-year fix to the SGR formula, Congress did not make any changes to the practice expense and work relative values implemented in the 2013 Medicare Physician Fee Schedule. Therefore, even with these congressionally mandated changes, dermatologists can expect to see reductions in 2013 in Medicare payments for some procedures (such as some complex repair codes and surgical pathology), whereas other payments may increase slightly (such as with laser treatments) (see related item above).

In an effort to provide enough time to revise the Fee Schedule, CMS is allowing Medicare claims administration contractors to hold Medicare claims with January 2013 dates of service for up to 10 business days (through Jan. 15, 2013). CMS expects that these claims will be released into processing no later than Jan. 16, 2013.

Dermatology practices are advised to submit claims based upon guidance from their Medicare contractors. Read more from CMS. For more information, email your specific questions to ppm1@aad.org.

CMS extends deadline for physicians to change participation status
The Centers for Medicare and Medicaid Services (CMS) announced on Jan. 2, 2013, that they have extended the 2013 Annual Participation Enrollment Program deadline from Dec. 31, 2012, to Feb. 15, 2013.

The 2013 Annual Participation Enrollment Program allows eligible physicians, practitioners, and suppliers an opportunity to change their participation status. Given this new deadline, participation elections and withdrawals must be post-marked on or before Feb. 15, 2013. The effective date for any participation status changes elected by providers during the extension still remains Jan. 1, 2013.

Dermatologists who wish to maintain their current participation status (PAR or Non PAR) do not need to take any action during the annual participation enrollment period. If you are not currently a Medicare participant and wish to participate, complete CMS Form 460 – Medicare participation agreement and mail a copy to your local Medicare contractor to which you submit Part B claims. If you are currently a Medicare participant and decide you no longer wish to participate in 2013, write to each Medicare contractor that you submit claims to, advising them of your termination. These written notices should be postmarked no later than Feb. 15, 2013.

Learn more about Medicare participation options. Email ppm1@aad.org with specific questions.

AADA joins AMA in urging CMS to abandon ICD-10
The American Academy of Dermatology Association (AADA) has signed on to a letter from the American Medical Association (AMA) urging the Centers for Medicare and Medicaid Services (CMS) to eliminate the implementation of the new patient diagnosis coding set ICD-10. The letter maintained that the implementation of ICD-10 will create significant administrative and financial burdens on physician practices with no direct benefit to individual patient care, and could force many physicians in small practices out of business. Additionally, implementation could disrupt physician plans to adopt Electronic Health Records, as well as participation in delivery and payment reform models.

At the November AMA House of Delegates Interim Meeting, delegates adopted a resolution that opposes the transition to ICD-10 and supports delaying any mandatory transition until the ICD-11 coding set — currently open for review and comment — is released. Currently, CMS is requiring that providers switch to the ICD-10 codes by October 2014, and members should continue their efforts to prepare for implementation. Resources are available on the AAD website at www.aad.org/icd-10 . The Academy will continue to report on progress of efforts to eliminate this requirement.

AADA assists CMS in Physician Compare website development
The American Academy of Dermatology Association (AADA) has been working with the Centers for Medicare and Medicaid Services (CMS) to ensure that dermatology is accurately represented in CMS’s search functionality in the new Physician Compare website.

Physician Compare is a tool aimed at helping patients find Medicare-participating physicians in their communities. The site—scheduled to be launched in March—will include a search box where users can enter medical-related terms and phrases such as a specialty name, condition, symptom, medical procedure, body part, or even an organ system. The site then suggests potentially relevant specialties to the user. Once a user selects a specialty, he or she will see a list of physicians or other health care professionals matching the specialty within his or her specified geographic location.

Specifically, the AADA worked with CMS, through its contractor, to review and provide a more comprehensive list of dermatological keywords to ensure optimal searchability.

The 2010 Patient Protection and Affordable Care Act required that CMS replace the Physician Directory on its website with the Physician Compare tool. Read more about the AADA’s involvement on the Physician Compare website development. Contact AADA’s Richard Martin for more information.

FDA issues alert to 350 practices on onabotulinumtoxinA
The U.S. Food and Drug Administration (FDA) has alerted more than 350 medical practices that they may have received unapproved medications — including unapproved versions of Allergan’s Botox, onabotulinumtoxinA — from foreign suppliers owned and operated by Canada Drugs and known under the following names: Quality Specialty Products (QSP), A+ Health Supplies, QP Medical, Bridgewater Medical, or Clinical Care. The FDA warns that these medications may be counterfeit and/or unsafe, and therefore advises that practices stop administering these unapproved versions of Botox. Read more FDA advice for health care providers on this issue. The American Academy of Dermatology Association will provide updates as they are made available.

Private payer activity

AADA opposing Blue Cross Blue Shield Tenn. consolidation of outpatient laboratory services
The American Academy of Dermatology Association (AADA) and the Tennessee Dermatology Society (TDS) wrote a letter to Blue Cross and Blue Shield of Tennessee (BCBST) regarding the Volunteer State Health Plan’s (VSHP) consolidation of outpatient laboratory services to Quest Diagnostics.

The AADA and TDS are specifically concerned that this policy denies dermatologists the ability to perform CPT 88304, 88305, 88312, 88313, and 88342 in their office setting. The current policy permits the billing of these codes only for the outpatient surgical setting. Additionally, the AADA and TDS are concerned that the exclusive dermatopathology lab service arrangement with Quest Diagnostics requires office-based diagnostic services to be referred to a lab outside of Tennessee, leading to longer turnaround times.

The VSHP — which is a subsidiary of BCBST and a managed care organization for the state’s Medicaid program — notified network providers of its plan to consolidate lab services to Quest Diagnostics in a letter dated May 30, 2012. The policy was originally intended to be implemented on July 1, 2012, but was delayed to Oct. 1, 2012, and further revised to exclude several other codes due to the work of the Tennessee Medical Association. For more information, or for questions on this issue, contact Jacqueline Buschmann.

State policy roundup

AADA, Oregon Dermatology Society oppose amendments to office-based surgery rules
The American Academy of Dermatology Association (AADA) and the Oregon Dermatology Society (ODS) have submitted a letter to the Oregon Medical Board opposing changes to the Oregon Administrative Rules (OAR) on office-based surgery.

The proposed amendments would require that physicians and all clinical staff maintain active Basic Cardiac Life Support (BCLS) certification in offices where Level 1 surgeries are performed. Level 1 surgery includes procedures with local anesthesia or minimal sedation. The AADA and ODS also opposed the board’s recommendation to require written informed consent from patients before Level 1 surgeries.

Scott Collins, MD, testified on behalf of the AADA as well as the American Society for Dermatologic Surgery, and Bert Tavelli, MD, testified on the behalf of the ODS, stating that although the organizations share the Board’s concern for patient safety, and the need for appropriate emergency protocols in office-based settings, the proposed rules exceed what is appropriate according to level of anesthesia. Read more about AADA and ODS opposition to these, and other amendments to the OAR rules. For more information on this issue, contact AADA’s Kersten Burns at kburns@aad.org.

AADA launches melanoma reporting resource
The American Academy of Dermatology Association (AADA) has developed a melanoma reporting resource designed to help dermatologists find out more information about individual state reporting requirements and registries.

Dermatologists are required by state laws to report all new cases of melanoma to their state’s central cancer registry. However, recent studies indicate that some dermatologists are unaware of this obligation, or do not use the state registry to report melanoma cases. This underreporting of melanoma results in an underestimation of the true incidence of this disease, and inhibits states’ abilities to identify disease trends, track disease outbreaks, and aid in preventive measures.

Learn more about your state’s cancer registry and reporting requirements. For more information, contact AADA’s Kersten Burns at kburns@aad.org.

Political affairs – SkinPAC

SkinPAC gears up for 2014 election cycle
As the American Academy of Dermatology Association’s Political Action Committee, SkinPAC, gears up for the 2014 election cycle, it is also celebrating its record-breaking 2012 election cycle. SkinPAC surpassed the $1 million mark in August to raise more than $1,085,000. Additionally, 94 percent of the candidates who received SkinPAC funding won their elections.

SkinPAC’s growth and momentum is very important as the new 113th Congress will address many critical issues affecting dermatologists and their patients, particularly with regard to Medicare physician payment, as well as medical research and graduate medical education funding. For more information about SkinPAC, contact Katie Jones at 202-609-6333, or visit www.skinpac.org.

SkinPAC’s political purpose is to solicit and receive contributions to be used to make political campaign expenditures to those candidates for federal elective office, and other federal political committees, who demonstrate understanding and interest in the views and goals of the American Academy of Dermatology Association.

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