- 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
Guidance for Ultrasound Reports and Notes to Reduce Denials
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.
The AVF Health Policy Committee
AVF, SVS, and AVLS comment on the Blue Cross/Blue Shield of North Carolina policy for treatment of varicose veins of the lower extremity
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.
The AVF Health Policy Committee
2023 MEDICARE PHYSICIAN PAYMENT SCHEDULE FINAL RULE
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
AVF Partners with the Alliance for Wound Care Stake Holders to Optimize Treatment of Venous Leg Ulcers with Skin Substitutes
Venous leg ulcers are the most common indication for treatment in a wound center. Therefore, many venous specialists play pivotal roles in wound centers. In most cases, venous providers in wound centers provide the full gamut of advanced wound care therapies in addition to providing vein specific therapies.
The use of “Skin Substitutes” in the management of refractory Venous leg ulcers has been shown to be effective and is a covered service by most payers. However, the 2023: Hospital Outpatient Prospective Payment System (CMS-1772-P) proposed rule, lays out a variety of problematic changes; including changing the name of the product category, the size and anatomic location of wounds that can be treated, and the site of service where effective reimbursement can be obtained.
Seeing this as an extremely troublesome set of changes which would adversely impact our members’ ability to use “Skin Substitutes” (Cellularized Tissue Product (CTP)) for the benefit of our patients, the AVF Health Policy Committee worked via our membership in the Alliance for Wound Care Stake Holders to respond to Medicare (CMS). The proposed rule and our comment letter can be reviewed below. The AVF HPC will continue to advocate for you and your patients in all aspects of your practice.
Dr. Sheila Coogan, Chair – AVF Health Policy Committee
Dr. Mark Iafrati, Past Chair – AVF Health Policy Committee