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This week’s headline:

Congressional committees release Medicare payment reform proposal

Medicare physician payments would increase by 0.5 percent each year for five years under a new bipartisan agreement on Medicare physician payment reform which would repeal the sustainable growth (SGR) rate formula. The SGR Repeal and Medicare Provider Payment Modernization Act of 2014 would also replace the previously proposed valued-based performance program with a similar Merit-Based Incentive Payment System (MIPS), which includes prospective performance thresholds and offers flexibility in the imposition of performance requirements. The proposal also offers a 5 percent added incentive payment for physicians in Alternative Payment Models (APM), $40 million in technical assistance to small practices of 15 or fewer professionals for MIPS transition or APMs, and $15 million annually for quality measure development.

Other provisions include the following:

  • Phased-in cuts of 20 percent or more over two years beginning with the 2015 physician fee schedule.
  • Establishment of a program that promotes use of Appropriate Use Criteria for advanced diagnostic imaging.
  • Provisions similar to the Standards of Care Protection Act, which the AADA supports.
  • Physicians who opt out of Medicare to engage in private contracting with their patients would no longer be required to renew their opt-out status every two years.
  • Expanded list of criteria used to identify potentially misvalued services to include codes: that account for a majority of spending under the physician fee schedule; with substantial changes in procedure time; for which there may be a change in the site of service or a significant difference in payment between sites of service; services that may have greater efficiencies when performed together; or, with high practice expenses or high cost supplies.
  • Requires GAO report in 18 months regarding other Part B services for which use of clinical decision support mechanisms would be appropriate such as clinical diagnostic laboratory services.
  • The publishing of utilization and payment data on the Physician Compare website.

While the proposal does include changes that the AADA supports, the legislation does not include provisions to offset the more than $120 billion cost of reform. Read more about the proposal and how much payment reform is projected to cost. The AADA has been actively engaged in the efforts to reform the Medicare physician payment system, and will continue to provide updates as more information becomes available. For more information, contact Shawn Friesen at sfriesen@aad.org.

Other headlines:
Federal agency focus

Prepare for ICD-10 now: Participate in CMS ICD-10 testing March 3-7
The Centers for Medicare and Medicaid Services (CMS) will conduct an ICD-10 end-to-end-testing week, March 3-7, 2014, where providers will be able to submit test claims with dates of service of Oct. 1, 2013, or later and, in return, receive electronic acknowledgment confirming that the submitted test claims were either accepted or rejected. To participate, practices should ask their local Medicare Administrative Contractors (MAC) when registration will open. Learn more about the ICD-10 end-to-end testing, or visit your local Medicare Carrier website for specific instructions. Physicians and others covered by the Health Insurance Portability and Accountability Act (HIPAA) must adopt ICD-10 for all HIPAA-covered transactions by Oct. 1. For more information, visit the ICD-10 section of the AAD website, or contact ppm1@aad.org.

CMS Administrative Law Judge hearing backlog causing delays
Due to a significant backlog of Medicare claims appeals processing, Administrative Law Judge (ALJ) hearings through the Centers for Medicare and Medicaid Services (CMS) are delayed. While the ALJ generally issues a decision within 90 days of receipt of the hearing request, this timeframe may be extended for a variety of reasons. Learn more about filing a request for an ALJ Hearing. Physicians can expedite the appeals process by escalating to a Medicare Appeals Council (MAC) review within 60 days of being notified by the ALJ of the delay. The physician can request a MAC review outside of the 60 days if they can show “good cause” as to why they did not file an appeal on time. View a timeline of Medicare appeals. For more information, contact Richard Martin at rmartin@aad.org.

Take Action: Urge Congress to support skin cancer prevention
The American Academy of Dermatology Association (AADA) is calling on its members to contact their members of Congress urging their support of the Food and Drug Administration's (FDA) proposed order to strengthen regulations on indoor tanning devices. Visit the AADA Dermatology Advocacy Network to take action. On May 6, 2013, the FDA issued a proposed order that recommends against the use of tanning beds by minors under 18, calls for the reclassification of indoor tanning devices from a Class I to a Class II medical device, and requires labeling on indoor tanning devices that clearly communicates the risks of skin cancer to all users. Read more about the FDA proposed order. For more information, contact Amanda Grimm at agrimm@aad.org.

Dermatology sees spike in Mohs surgery audits on East Coast
The American Academy of Dermatology Association (AADA) is learning of an increase in the number of audits for Mohs surgery services in Connecticut and New York from Diversified Collection Services, Inc. (DCS) — the Recovery Audit Contractor for the East Coast. These are automated audits using the Centers for Medicare and Medicaid Services’ (CMS) claim-editing system, which reviews patients’ data without medical notes. This particular audit is looking at outside provider services such as pathology on the same date as Mohs. According to CMS, same-day, outside pathology negates the Mohs procedure. Learn more about responding to these audits with the Academy’s Medicare RAC Audit Survival Toolkit. For more information, contact ppm1@aad.org.

CMS requires labs to provide patients direct access to test reports
The Centers for Medicare and Medicaid Services (CMS) has amended the Clinical Laboratory Improvement Amendments (CLIA) and the Health Insurance Portability and Accountability Act (HIPAA) to require any laboratory that qualifies as a covered entity under HIPAA to provide copies of completed test reports to patients upon request. The CMS rule does not require laboratories to interpret test results for patients who request them, but expands patients’ access to their protected health information under HIPAA. For more information, contact Richard Martin at rmartin@aad.org.

Private payer advocacy

Narrowing of provider networks could cause undue harm to patients
Several health insurers have been narrowing the scope of the provider networks they offer and as a result, many dermatologists have been notified — either directly by the health insurer or indirectly by their patients — that they are being terminated from one or more of the health insurer’s products. American Academy of Dermatology Association (AADA) President-Elect Brett Coldiron, MD, and AAD Executive Director and CEO Elaine Weiss, JD, met with White House and key congressional officials this week to discuss this issue and relay the specialty’s concerns that narrowed networks will have devastating effects on patient access to quality care. The AADA will continue to work with policymakers on this issue, and will provide updates as more information becomes available. Physicians who have been terminated due to narrowing networks will need to retain a lawyer for legal advice on their specific cases. Additionally, the AADA has developed a step-by-step guide on how to respond. For more information, contact Leslie Stein Lloyd at lsteinlloyd@aad.org.

State policy roundup

Maryland dermatologists, ‘Save Your Skin’ coalition rally for stronger restrictions on indoor tanning
To increase skin cancer awareness and in support of recent legislation that would restrict minors under the age of 18 from indoor tanning, members of the American Academy of Dermatology Association and the Maryland Dermatologic Society provided free skin cancer screenings for legislators, their staff, and the general public at the Maryland State Capitol building this week. Prior to the screenings, the Maryland ‘Save Your Skin’ coalition held a press conference at which a proclamation signed by Gov. Martin O’Malley was presented to two skin cancer survivors, proclaiming Feb. 4 as Maryland Skin Cancer Awareness and Prevention Day. Read more about this event. For more information, contact Lisa Albany at lalbany@aad.org.

Kansas, New Hampshire and Hawaii join fight against indoor tanning
Legislation that would restrict minors under 18 from indoor tanning has been introduced in Kansas and New Hampshire, and has passed out of the House in Hawaii. The American Academy of Dermatology Association (AADA) is urging states to pass these restrictions. In an unexpected move, the American Suntanning Association has also endorsed the under-18 legislation in Kansas. Read more about the AADA’s advocacy efforts on state indoor tanning legislation. For more information, contact Lisa Albany at lalbany@aad.org.

Maryland legislation would expand naturopaths’ scope to include dermatology
Maryland lawmakers are considering legislation that would expand the scope of practice of naturopathy to include the practice of dermatology. Additionally, House Bill (HB) 402 would license naturopaths and create a State Board of Naturopathic Medicine. The American Academy of Dermatology Association (AADA) has opposed this bill, citing concerns over patient safety and quality of care. Read more about this bill and the AADA’s letter opposing HB 402. For more information, contact Lisa Albany at lalbany@aad.org.

Melanoma/Skin Cancer Detection and Prevention Month® advocacy resources available
The American Academy of Dermatology Association (AADA) is assisting members and state dermatological societies in promoting May as Melanoma/Skin Cancer Detection and Prevention Month® as a way to establish or enhance relationships with policymakers. State societies and members are encouraged to contact their governors and mayors to seek a proclamation raising awareness about skin disease. Resources for members to discuss Melanoma/Skin Cancer Detection and Prevention Month® are available online in the AAD Media Relations Toolkit. Members and state societies who are interested in pursuing a mayoral or gubernatorial proclamation can contact Victoria Houghton at vhoughton@aad.org for assistance.

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