U.S. House Passes the Removing Barriers to Colorectal Cancer Screening Act; Other Good News
Great News! On Wednesday, the U.S. House of Representatives passed an amended version of H.R. 1570, the Removing Barriers to Colorectal Cancer Screening Act. Passing this bill has been among the top ACG policy priorities for years. This is a big win for our patients across the country. The bill now moves to the Senate, where S. 668 currently has 61 cosponsors. ACG also recently joined a coalition of organizations urging congressional leadership to pass the bill before the end of the year. Urge your Senators to pass this important bill before Congress adjourns!
CMS Still Moving Forward with Medicare Cuts: We still need your advocacy help! Medicare physician payments are scheduled to be cut across most specialties in CY 2021 when increases to evaluation and management (E/M) services are implemented. GI procedures are scheduled to be cut roughly 10%.
But Progress on Capitol Hill! This week Sen. John Boozman (R-AR) introduced the Senate counterpart of the “Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020” (S. 5007/H.R. 8702). This bill delays these Medicare cuts for 2 years, maintains the scheduled reimbursement increases to E/M services, and allows more time for a permanent resolution. Reps. Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN) introduced the House version. We need your advocacy voice!
FDA Advisory Panel OK’s COVID-19 Vaccine: On Thursday, an independent U.S. Food and Drug Administration (FDA) advisory committee said that the benefits of Pfizer's coronavirus vaccine outweigh the risks, setting the stage for the FDA to approve emergency use of the shot for people 16 and older. The panel — comprised of academic scientists, doctors and officials from other federal health agencies — voted 17 to 4 in favor of the vaccine, with one member abstaining. While the FDA is not obligated to follow the advisory panel’s recommendation, the agency is expected to approve the vaccine within days (at the time of this writing). The results of the trial were also recently published in the New England Journal of Medicine.
ACG Webinar: On December 22, 2020 a panel moderated by ACG President David A. Greenwald, MD, FACG will discuss the accelerated timeline for COVID-19 vaccines, review the role of CDC's Advisory Committee on Immunization Practices (ACIP), and discuss mRNA vaccines in the context of gastroenterology. Click here to register!
CMS Releases Proposed Rule on Prior Authorization: This week, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule designed to increase the transparency and efficiency of the prior authorization process. The rule impacts Medicaid, CHIP and qualified health plan (QHP) payers, who would be required to build software, or application program interfaces (APIs), to help streamline the process. The rule does not impact Medicare fee for service or Medicare Advantage plans (CMS is considering whether to do so in future rulemaking). This rule includes five sets of proposals, starting January 2023. Among the proposed changes, payers would have to provide an answer to a prior authorization request within 72 hours of any urgent request, or 7 calendar days for any standard request. CMS is also proposing to require payers to publicly report data, such as the percent of prior authorization requests approved, denied, and ultimately approved after appeal, as well as the average time between submission and determination. CMS proposes the initial set of these metrics to be reported by March 31, 2023.
Click here to read CMS Administrator Seema Verma’s blog post.
Click here to view the proposed rule.
Click here to view the fact sheet.
Prior authorization and step therapy requirements continue to hinder GI patient care. ACG is reviewing the proposed rule and will continue to advocate for necessary changes to streamline these processes and reduce provider burdens.
2020 MIPS Hardship Exemption Still Available: CMS also recently announced that the MIPS "Extreme and Uncontrollable Circumstances" Application was recently extended until February 1, 2021. It was previously open until December 31, 2020. The “Extreme and Uncontrollable Circumstances” policy allows MIPS eligible clinicians, groups, and virtual groups to submit an application requesting a reweighting of one or more MIPS performance categories to 0%. Submit an application now and be sure to cite COVID-19 as the reason for your application. If approved, you can still receive scores for the Quality, Improvement Activities, and Promoting Interoperability MIPS performance categories. Please note that if the Cost performance category is included in your approved application, you will not be scored on cost measures even if other data are submitted. Learn more in the 2020 Exceptions Applications Fact Sheet.
ASCs and Hospitals Will Receive a Medicare Facility Fees Increase in 2021
This week, ACG and other GI societies recently alerted membership that CMS finalized two policy rules impacting payment to physicians, hospitals and ambulatory surgery centers (ASCs). Changes finalized in the Outpatient Prospective Payment System (OPPS) and ASC Final Rule were largely positive. The conversion factors for both hospitals and ASCs meeting quality reporting requirements increased 2.5 percent.
2021 conversion factors:
- $82.797 for hospitals meeting facility quality reporting requirements
- $48.952 for ASCs meeting the quality reporting requirements
Here are the key things to know for the OPPS and ASC final rule:
- No ASC cost reporting requirements
- CMS finalized approval for:
- HCPCS code C1748 (Endoscope, single-use (that is, disposable), upper GI, imaging/illumination device (insertable)) which can be used for EXALT™ Model D Single-Use Duodenoscope, Ambu aScope™ Duodeno or any FDA approved single-use, disposable duodenoscope through June 30, 2023
- Device pass-through payment status for Hemospray® Endoscopic Hemostat
- Device pass-through payment status for EXALT™ Model D Single-Use Duodenoscope under the alternative pathway
2021 OPPS and ASC payment tables:
- 2021 OPPS payments for GI services
- 2021 OPPS payment chart for top 10 base and biopsy codes
- 2021 ASC payments for GI services
- 2021 ASC payment chart for top 10 base and biopsy codes
2021 OPPS/ASC CMS resources:
The ACG Endoscopy Resumption Task Force Continues to Monitor Rise in COVID-19 Cases and Hospitalizations
From Co-Chairs of the ACG Endoscopy Resumption Task Force, Neil H. Stollman, MD, FACG and Costas H. Kefalas, MD, MMM, FACG
“Federal guidance is extensive, but local regulations and conditions dominate”
The ACG Board of Governors and the ACG Endoscopy Resumption Task Force are closely monitoring the recent spikes in COVID-19 cases and hospitalizations in certain areas of the country, including recent announcements to further delay elective procedures. The CDC has guidance for who should be tested, but decisions about testing requirements, vaccinations, and reopening are made att he state and local level. Interested in learning more on the latest information on your state? Your state governor's website will have the latest information on COVID-19 prevalence and plans for reopening. The Council of State Governments website is tracking information on your state (updated regularly).
The ACG Guidance on Safely Reopening Your Endoscopy Center recognizes that not all areas of the country are the same, and each region/state is dealing with various levels of COVID-19 prevalence, ability to test patients/staff, as well as the ability to access personal protective equipment.
What is the Practice Management Toolbox?
The Toolbox is a series of short articles, written by practicing gastroenterologists, that provide members with easily accessible information to improve their practices. Each article covers an issue important to private practice gastroenterologists and physician-lead clinical practices. They include a brief introduction, a topic overview, specific suggestions, helpful examples and a list of resources or references. Each month a new edition of the Toolbox will be released and will then remain available here along with all previous editions. The Practice Management Committee is confident this series will a provide valuable resource for members striving to optimize their practices.