The American Venous Forum is committed to promoting evidence-based best practices to ensure that patients have access to the highest quality care – especially the underserved.

We believe that vigorous advocacy in venous and lymphatic disease is critical to this commitment.

The AVF is actively advocating on behalf of our members and the patients they serve.  The following are just a few of the comment letters we have submitted as the AVF or as part of a larger coalition:

• AVF, SVS, & AVLS Letter to BCBS 
• AVF Letter to CMS
• Coalition – CY 2022 Payment Policies under the Physician Fee Schedule
• Coalition – CY 2022 Payment Policies under the Physician Payment Schedule and Other Changes to Part B Payment Policies
• AVF and SVS Comment to CMS – Transvenous Pulmonary Embolectomy NCD

In recent years, many physicians and non-partisan government stakeholders have expressed concerns about the failure of Medicare payments to keep up with inflation and the rising costs of running a medical practice, as well as the negative impact it could have on patient access to care.

On April 4, 2023, a bipartisan group of doctors came together in Congress to introduce H.R. 2474, the Strengthening Medicare for Patients and Providers Act.

This legislation addresses uncertainty affecting Medicare-participating physicians and will help avoid a possible physician shortage for Medicare patients. H.R. 2474 would change the physician payment rate by providing an annual Medicare physician payment update tied to inflation, as measured by the Medicare Economic Index (MEI).

The legislation was introduced by Representatives Raul Ruiz, M.D. (D-CA-25), Larry Bucshon, M.D. (R-IN-08), Ami Bera, M.D. (D-CA-06), and Mariannette Miller-Meeks, M.D. (R-IA-01). Bill text for H.R. 2474 can be found here.

Please join us in contacting your legislator to support H.R. 2474.

Dear AVF Members,

The AVF Health Policy Committee meets monthly on your behalf to discuss issues dealing with payer policies, reimbursements, denials, and other concerns that arise from time to time. We all have had payer denials for pre-authorization and reimbursements for venous procedures. The following tool arose from our discussions.  We believe it may help you to decrease or eliminate denials by including in your documentation all of the suggested criteria required by payers. We do not have templates, as there are many EHRs, so they would have to be created in your particular EHR. The HPC hopes this guide will be of benefit to your practice.

View or download the Guidance for Ultrasound Reports and Notes to Reduce Denials.

Sincerely,

The AVF Health Policy Committee

Dear colleagues,

With all the attention appropriately focused on Medicare (Labor update, Conversion factor, Budget neutrality, etc.), it would be easy to lose sight of Commercial Insurance varicose vein coverage policies. However, rest assured the AVF Health Policy Committee in collaboration with the SVS and AVLS continue to support our members, as you address polices and denials which are at times capricious and others systematically restrictive. Among the most egregious policy is the long standing BCBS North Carolina Policy restricting venous procedures to one vein, per leg per life. We continue to push for a change to this policy at the regional and national level. See our latest letter to BCBS. We have and will continue to be responsive to communications from our members, who receive unjust denials, or are faced with perverse policies. If this has happened to you, please post in the AVF exchange or email [email protected].

During the last year, the Health Policy Committee adopted a more proactive approach. Leveraging our powerful new tool Policy Navigator, we have up to date venous policy documents for all commercial and private payors in the US. Not only can we quickly review current policies, but we can see proposed changes and respond in time to impact policy.  The Venous Policy Navigator is available for use in your office and can greatly reduce the work required to stay on top of the rules of the road in your region. Learn more about Policy Navigator here.

The AVF Health Policy committee is committed to supporting venous practitioners in your efforts to bring high quality care to your patients and to ensure that reimbursements systems support continued access to care.  Let us know how we can help you.

Sincerely,

The AVF Health Policy Committee

Today, the Centers for Medicare & Medicaid Services (CMS) released the 2023 Medicare Physician Payment Schedule final rule. Notably, CMS adopted the revised CPT guidelines and codes and the AMA/Specialty Society RVS Update Committee (RUC) recommended relative values for additional E/M visit code families, including hospital visits, emergency department visits, home visits and nursing facility visits. These changes allow time or medical decision-making to be used to select the E/M visit level. In total, the E/M code sets being revised for 2023 comprise approximately 20 percent of all allowed charges under the Medicare Physician Payment Schedule. Therefore, these changes are estimated to require a reduction of about 1.6 percent to the 2023 Medicare conversion factor due to statutory budget neutrality requirements.

The CY 2023 Medicare conversion factor (CF) is $33.06, a decrease of $1.55 or 4.5% from the 2022 CF of $34.61. The decrease is largely a result of an expiring 3 percent increase funded by Congress through 2022. The additional approximate 1.6 percent decrease is the result of budget neutrality requirements that stem from the revised E/M changes. The AMA and the Federation are strongly advocating that Congress avert this payment cut, as well as implement an inflationary update for physicians, extend the 5 percent Advanced APM incentive and prevent the steep increase to the participation requirements for APMs, and waive the 4 percent PAYGO sequester. 

In response to the Consolidated Appropriations Act, which extended payment for telehealth services to all communities in the country, not just rural areas, and allowed patients to receive telehealth services in their home for 151 days, or five months, after the end of the COVID-19 public health emergency (PHE) ends, CMS finalized its proposal to extend telehealth coverage for the codes that were only going to be on the telehealth list through the end of the PHE for an additional five months.

AMA staff are closely reviewing the final rule and will draft a detailed summary and analysis to share shortly. Please see the following documents for more information:

• Final Rule – https://www.cms.gov/files/document/cy2023-physician-fee-schedule-final-rule-cms-1770f.pdf
• CMS Press Release – https://www.cms.gov/newsroom/press-releases/hhs-finalizes-physician-payment-rule-strengthening-access-behavioral-health-services-and-whole
• CMS Fact Sheet – https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2023-medicare-physician-fee-schedule-final-rule
• CMS QPP Fact Sheet – https://qpp-cm-prod-content.s3.amazonaws.com/uploads/2136/2023%20Quality%20Payment%20Program%20Final%20Rule%20Resources.zip
• CMS MSSP Fact Sheet – https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2023-medicare-physician-fee-schedule-final-rule-medicare-shared-savings-program