Neurosurgery Leads Amicus Brief Effort in Surprise Billing Lawsuit
On Dec. 9, the American Medical Association (AMA) and American Hospital Association (AHA) filed suit against the Biden Administration to stop part of the surprise billing regulations from going into effect in January. The interim final rule (IFR) implementing the No Surprises Act requires arbitrators to primarily use the “qualifying payment amount” (QPA), which is based on median in-network rates, in deciding billing disputes over out-of-network services. However, as pointed out in the lawsuit, the statute clearly states that the arbitrator “shall” consider many factors, not just the QPA, in determining fair payments. These factors include the doctor’s experience and level of training, the complexity of the service, and prior contract history between the plan and provider.
The Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS) spearheaded a physician-led amicus brief, along with the Physician Advocacy Institute, supporting the AMA/AHA lawsuit. Seven national and 16 state medical societies also joined the brief. The physician organizations strongly support protecting patients from unanticipated medical bills, and neither the amicus brief nor the lawsuit challenges the patient protection elements of the rule.
Click here to read the amicus brief, here for the joint press release and here for neurosurgery’s press release.
Neurosurgeons Must Now Comply with No Surprises Act
The No Surprises Act (NSA) took effect on Jan. 1. Included in the Consolidated Appropriations Act, 2021 (P.L. 116-260), the NSA protects patients from surprise medical bills and outlines rules providers must follow when delivering out-of-network care, including the process for resolving payment disputes. The law also includes provider price transparency provisions for patients considering or scheduling care, requiring providers, including physicians and facilities, to notify patients of their right to receive a good faith estimate. The NSA also requires health plans to maintain accurate provider directories and verify provider information every 90 days. Physicians are required to submit regular updates to health plans to assist with their verification and updates to the provider directory information.
Neurosurgeons should become familiar with the law’s requirements. A plethora of resources is available, including:
Neurosurgery Opposes Bill to Give Trial Lawyers Tax Breaks
On Dec. 17, 2021, the Health Coalition on Liability and Access (HCLA) — a coalition of associations and businesses representing physicians and other health care providers, hospitals, medical liability insurers, employers and health care consumers — wrote a letter urging the removal of Sec. 138518, Expenses in Contingency Fees Cases, from the Build Back Better Act (H.R. 5376). The letter — sent to House Speaker Nancy Pelosi (D-Calif.), House Minority Leader Kevin McCarthy (R-Calif.), Senate Majority Leader Charles Schumer (D-N.Y.) and Senate Minority Leader Mitch McConnell (R-Ky.) — expressed concerns that Sec. 138518 would provide no substantive benefit to either claimants or defendants in the litigation process. The HCLA supports resolving liability claims without resorting to litigation.
Click here to read the HCLA letter.
CNS and AANS Endorse Cerebral Cavernous Malformations Research Bill
On Dec. 15, 2021, the CNS and the AANS sent a letter supporting the Cerebral Cavernous Malformations Clinical Awareness, Research, and Education (CCM-CARE) Act (S. 3390). Sponsored by Sens. Ben Ray Luján (D-N.M.) and Martin Heinrich (D-N.M.), this legislation would provide crucial insights into cerebral cavernous malformation (CCM) by expanding research at the National Institutes of Health, the Centers for Disease Control and Prevention and the U.S. Food and Drug Administration, to increase awareness, treatment and prevention of the condition. CCM is a devastating, rare genetic blood vessel disease that impacts the brain and spinal cord in over 600,000 Americans. Most people with the disease do not realize they have it until they experience symptoms, including neurological deficits, seizures, stroke or sudden death.
Click here to read the letter.
Coding and Reimbursement
Doximity Report Shows Neurosurgery Tops Physician Compensation
According to Doximity’s 2021 Physician Compensation Report, physician salaries increased 3.8% from 2020 to 2021. The survey of more than 40,000 full-time U.S. physicians for this year’s report found neurosurgery is the specialty with the highest average annual compensation, at $773,201. Male doctors earn over $122,000 more than their female counterparts annually, and men make over $2 million more than women throughout their careers.
Click here to read Doximity’s 2021 Physician Compensation Report.
CMS Seeks Feedback on Low Back Pain Cost Measure
CMS and its contractor, Acumen, LLC, will conduct field-testing for five newly developed episode-based cost measures, including a low back pain cost measure, from Jan. 10 through Feb. 25. Field-testing allows CMS to collect feedback and refine this measure before it is tied to Medicare physician payment adjustments under the Merit-Based Incentive Payment System (MIPS). Neurosurgeons are encouraged to take advantage of this opportunity to provide input.
Click here for additional information about the measure, how to access your field test report and how to submit feedback.
CMS Publishes Missing Digital Contact Information Report
CMS recently published the National Plan and Provider Enumeration System (NPPES) Public Reporting of Missing Digital Contact Information Report. The Report contains the names and National Provider Identifiers (NPIs) of providers who do not have digital contact information, also known as “endpoints,” included in the NPPES system as of Dec. 17, 2021. Endpoints allow health care providers to send authenticated, encrypted health information directly to trusted recipients securely over the internet. To facilitate electronic health information exchange, CMS finalized its May 2020 CMS Interoperability and Patient Access final rule that it would publicly report the names of providers who do not list or update their digital contact information in the NPPES. The NPPES Missing Digital Contact Information Report will be updated quarterly, and providers may add missing digital contact information before publication the next report. Updated data that comes after the end of March 2022 will be displayed on the next quarterly refresh. Access additional resources:
MIPS 2021 Data Submission Period Now Open
CMS has opened the data submission period for eligible clinicians who participated in the 2021 performance year of the MIPS. Data can be submitted and updated from now until March 31 at 8:00 p.m. EST. Additional information about how to submit data is available here.
MIPS eligible clinicians should also start seeing 2022 MIPS payment adjustments, based on 2020 performance, applied to payments made for Part B covered professional services payable under Medicare. Payment adjustments are determined by the final score associated with a clinician’s Taxpayer Identification Number/NPI combination. View the 2022 MIPS Payment Adjustment User Guide for more information on these adjustments.
Click here to access materials related to 2021 MIPS data submissions, 2022 data collection and other policies that impact alternative payment model participants.
Neurosurgeon Highlighted in Article about AMA/AHA Surprise Billing Lawsuit
On Jan. 10, MedCity News published an article titled “Physicians Group Files Brief Supporting AMA/AHA Lawsuit,” highlighting the amicus curiae brief filed by the CNS, AANS and other physician groups, backing the AMA and AHA’s lawsuit opposing the dispute regulation guidelines of the NSA that went into effect Jan. 1. “This deeply flawed regulation represents an approach Congress dismissed because it recognized that failure to consider multiple factors before deciding a payment dispute would make it harder and more costly for patients to access physicians, particularly for specialty care,” said John K. Ratliff, MD, FAANS a practicing neurosurgeon and chair of the CNS/AANS Washington Committee.
Neurosurgery Groups Featured in Article about Spine Surgery
On Jan. 13, Becker’s Spine Review published an article titled “Leave spinal fusions to the surgeons, spine societies warn.” The article referenced the position statement drafted by the CNS/AANS Joint Section on Disorders of the Spine and Peripheral Nerves. The article points out that the position statement, which is endorsed by eight neurosurgical and orthopaedic surgery societies, notes that as “patient demand for minimally invasive techniques has increased, a significant number of non-surgeon clinicians now perform arthrodesis procedures that alter the biomechanics of the spine — despite the fact that arthrodesis of the spine remains outside the scope of training curriculum of physiatrists and pain management anesthesiologists who are currently performing these procedures.” It goes on to highlight the groups’ position: “Optimal patient care and patient safety are best served when surgical diseases affecting the spine are managed by neurosurgeons and orthopedic spinal surgeons trained in the full spectrum of spinal biomechanics, including instrumentation and fusion techniques. Therefore, arthrodesis or any other intervention that alters the biomechanics of the spine should not be performed by practitioners in other fields outside of specialty-trained neurosurgery or orthopedic spinal surgeons.”
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