Dear NVOS Members,
We have been alerted by AAOS that Nevada is one of nine states to be included in a geographic sampling where CMS has mandated new reporting of postoperative follow-up visits. The new system takes effect on July 1, 2017. See the details here:
https://www.aaos.org/AAOSNow/2017/Jun/Managing/managing02/
https://www.karenzupko.com/medicare-sharpens-focus-global-surgical-package/
BACKGROUND:
The Centers for Medicare & Medicaid Services (CMS) has expressed concern that services with 10- and 90-day postoperative periods are not valued accurately, and follow-up visits included in the value of the global services are not consistently being performed. Consequently, as required by the Medicare Access and CHIP Reauthorization Act (MACRA), CMS mandated the reporting of postoperative visits for 293 Current Procedural Terminology (CPT) codes for providers in nine states beginning July 1, 2017.
These postoperative visits should be reported with CPT code 99024, which the CPT book uses to describe “a postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure.”
In the nine states, 99024 reporting will be required on Medicare fee-for-service claims in groups with 10 or more practitioners. Physician or qualified nonphysician practitioners (eg, nurse practitioner, physician assistant) who furnish services to patients are included when enumerating a group’s practitioners. These practitioners do not need to share the same physical address to be considered part of the same practice, but may share a tax identification number. Physicians in teaching hospitals are included in this mandatory reporting requirement.
The place of service designations where reporting must occur include, but are not limited to, inpatient hospital, outpatient hospital, ambulatory surgical center (ASC), intensive care unit, critical care unit, skilled nursing facility, or a physician’s office. This means that inpatient postoperative hospital rounding visits related to the surgical procedure would be reported, a dramatic departure from current practice, wherein many of these encounters are not tracked at all.
In the proposed rule, CMS recommended collection of post-operative data in three ways.
- The first prong would collect claims-based data on the number and level of visits in 10-minute increments from all physicians who perform Global Code (G-code) procedures.
- The second method would be a survey pf physicians.
- The third method would be data collection from the accountable care organizations (ACOs).
The claims-based universal data gathering proposal was deemed extremely burdensome on surgeons and not in line with the intent of the Medicare Access and CHIP Reauthorization Act (MACRA) statute. AAOS commented to CMS explaining these issues as well as joined other surgical specialties in legislative and regulatory advocacy efforts to urge CMS to reverse this proposal.
Subsequently, in the final rule with comments [Regulation No. CMS-1656-FC] (available online at: https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-26515.pdf), CMS finalized three major flexibilities in reporting requirements as follows:
1. CPT code 99024 can be used to collect data on the number of post-operative visits (as suggested by AAOS and others). Further, at this time, CMS will not require time units or modifiers to distinguish levels of visits to be reported.
2. Instead of required reporting on all codes, CMS is just collecting data on the number of visits for codes that are reported annually by more than 100 practitioners and with high volume or high allowed charges (furnished more than 10,000 times or have allowed charges of more than $10 million annually as recommended by the RUC (AMA RVS Update Committee) and many other commenters including AAOS).
3. Instead of collecting data from all physicians who perform global code procedures, CMS has finalized reporting requirements for a geographic sample of practitioners located only in the following states: Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon and Rhode Island.
Moreover, the start date for implementation of such data collection has been postponed from January 1, 2017 to July 1, 2017. At this time, CMS is not implementing the statutory provision that authorizes a 5 percent withhold of payment for the global services until claims are filed for the post-operative care, if required. The proposals regarding the physician survey and data collection in ACO have been finalized as proposed.
“CMS is hopeful that use of the existing CPT code for reporting these services will be significantly less burdensome than the proposal to require time-based reporting using the G-codes,” the agency wrote in a summary. “[W]hile practitioners are encouraged to begin reporting post-operative visits for procedures furnished on or after January 1, 2017, the requirement to report will be effective for services related to global procedures furnished on or after July 1, 2017. To the extent that these data result in proposals to revalue any global packages, that revaluation will be done through notice and comment rulemaking at a future time.”
Since reporting via the 99024 CPT code will only provide information on the number of visits, CMS will explore whether a survey would provide data on the level of visits (needed to value surgical services correctly) as mandated by the MACRA statute.
AAOS will continue to monitor future rule making on this issue.