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Proposed CMS rule overhauls E/M visit codes, reduces modifier 25 payment

June 12, 2018

The Centers for Medicare and Medicaid Services (CMS) today released its proposed 2019 Medicare Physician Fee Schedule rule, which also includes changes to its proposed policies for the 2019 Quality Payment Program (QPP) established under the Medicare Access and CHIP Reauthorization Act (MACRA). In addition to proposing an overhaul of evaluation and management (E/M) visits, the AADA is very concerned that CMS also is proposing a payment reduction for E/M visits billed with a procedure.

AADA staff continues analyzing the proposed rule and plans to submit comments to CMS by Sept. 10, 2018. This Academy webpage includes the AADA's initial topline analysis of the proposed rule, and will be updated with additional details following further review. Information will also be made available in Dermatology World Weekly.


Anthem RESCINDS proposed modifier 25 policy in win for AADA, AMA, patient care

February 23, 2018

Anthem, Inc. today announced it is rescinding its proposed policy to reduce reimbursement by 25% for E/M services billed with a modifier 25. Anthem’s initial proposal had been a 50% cut, which they reduced and delayed 3 months in response to AADA advocacy. Recent AADA advocacy included a letter to Anthem earlier this week encouraging the payer to retract its policy. 

Learn more in the President's Message from AAD/A President Suzanne Olbricht, MD.


AADA joins letter opposing modifier 25, other Anthem payment changes

January 16, 2018

The AADA joined medical specialty societies and patient advocacy groups in sending a letter to Anthem's chief clinical officer to express concerns about controversial changes to Anthem payment policies. The letter urges the insurer to rescind plans to 1) reduce physicians' reimbursement when they bill for E&M services billed with a modifier 25, 2) largely deny advanced imaging performed in the hospital outpatient setting, and 3) deny coverage for services provided to beneficiaries for retroactively determined "non-emergent" health care services in the Emergency Department. The letter states that "Anthem finalized these changes despite mounting evidence that the justification for the policies is flawed and would hinder patients' access to physician care."

Click here to read the letter.


Anthem delays, alters proposed modifier 25 policy following AADA, AMA advocacy

December 22, 2017

Anthem, Inc. announced on Dec. 22, 2017 that, while it will still be reducing reimbursement for E&M services billed with a modifier 25, reimbursement will be reduced by 25 percent rather than by 50 percent, as was originally announced. Anthem also announced that the policy will go into effect March 1, 2018 in California, Colorado, Connecticut, Indiana, Kentucky, Maine, Missouri, New Hampshire, Nevada, New York, Ohio, and Wisconsin. For some states, this is a delay in implementation. Anthem also indicated that the policy will be effective in Georgia and Virginia upon network contract renewal. Click here to read the Academy's Breaking News Alert for more on the American Academy of Dermatology Association's efforts to fight Anthem's proposed policy change along with the American Medical Association (AMA), other medical specialties, and state dermatologic societies.

 


AADA opposes misvalued codes, urges action on sequester

December 20, 2017

The AADA sent a letter to leadership of the U.S. Senate and U.S. House of Representatives opposing Medicare cuts to physician payments through either an extension of the misvalued codes policy or through an additional sequester of Medicare funds. To read the letter, click here.


AADA, coalition letter on preserving patient access to Part B treatments

December 6, 2017

Several medical societies including the American Academy of Dermatology Association sent a letter to Congressional leaders urging them to preserve patients' access to critical Part B drug treatments by preventing the Centers for Medicare and Medicaid Services (CMS) from applying Merit-based Incentive Payment System (MIPS) score adjustments to Medicare Part B payments. In its 2018 Quality Payment Program (QPP) final rule, CMS announced it will be imposing these payment adjustments to Part B drug payments in addition to physicians' services under the Medicare fee schedule.  The letter requests a technical correction to curtail this policy and preserve patient access to the services and treatments they need.  To read the letter, click here.


AMA HOD adopts modifier 25 resolution

November 14, 2017

The American Medical Association (AMA) House of Delegates (HOD) has adopted a resolution that was authored by the American Academy of Dermatology delegation and Dermatology Section Council (DSC) to address insurers’ attempts to reduce reimbursement for modifier 25. The resolution, triggered by recent announcements that Anthem Blue Cross Blue Shield and Independence Blue Cross will reduce reimbursement for modifier 25 in several states, calls on the AMA to aggressively and immediately advocate through any legal means to see that insurers comply with accepted CPT coding and reimbursement guidelines.

Furthermore, the AMA President and AMA Board Chair met with the DSC to address the AADA's concerns, and stated that they would act aggressively in opposition to these types of policies.

Final language of the resolution:

RESOLVED: That our American Medical Association aggressively and immediately advocate through any legal means possible, including direct payer negotiations, regulations, legislation, or litigation, to ensure when an evaluation and management (E&M) code is appropriately reported with a modifier 25, that both the procedure and E&M codes are paid at the non-reduced, allowable payment rate.

Additionally, the AADA and state dermatologic societies sent a letter to the Blue Cross Blue Shield Association (BCBSA) highlighting concerns with BCBSA member plans' proposals to reduce reimbursement for modifier 25 in several states effective January 1, 2018. To read the letter, click here.


AADA, state derm societies fight modifier 25 policy change with BCBSA, at AMA

November 13, 2017

The American Academy of Dermatology Association (AADA) and state dermatologic societies today sent a letter to the Blue Cross Blue Shield Association (BCBSA) highlighting concerns with BCBSA member plans' proposal to reduce reimbursement for modifier 25 in several states effective January 1, 2018. To read the letter, click here.

Additionally, the American Medical Association (AMA) House of Delegates will be voting on a resolution that addresses insurers' attempts to reduce reimbursement for modifier 25. The AADA has led the efforts in drafting the resolution, which calls on the AMA to urge insurers to comply with accepted CPT coding and reimbursement guidelines.

The Academy has developed a number of resources for members on appropriate usage and documentation of modifier 25. To sign up for updates on modifier 25 advocacy efforts, fill out the form here.


AADA fights modifier 25 policy change

October 27, 2017

The American Academy of Dermatology (AADA) is concerned about payers' policy to reduce reimbursement for modifier 25, and is working closely with state dermatology societies and other medical specialty societies in an effort to reverse this policy. Today the AADA held a conference call with Anthem Blue Cross Blue Shield, which will be reducing reimbursement for modifier 25 in California, Connecticut, Kentucky, Maine, Nevada, New Hampshire, Ohio, and Wisconsin starting with claims processed on or after Jan. 1. The AADA expressed its concerns that the policy contradicts well-accepted coding conventions and guidelines, and also issued a letter to Anthem in conjunction state dermatology societies further explaining that the policy is an inappropriate reduction of modifier 25 and should be reconsidered.

The AADA will continue fighting this policy change. To sign up for updates on modifier 25 advocacy efforts, fill out the form here.


Academy comments on proposed ’18 Fee Schedule

September 7, 2017

The AADA has submitted to the Centers for Medicare & Medicaid Services (CMS) its comments on the proposed 2018 Medicare Physician Fee Schedule, which was released in July.  In its comments letter, the AADA requests a number of technical changes to the proposed valuation of specific codes, recommends that CMS accept RVU Update Committee (RUC)-recommended times and RVUs, and expresses concern regarding prior authorization requirements, drug pricing, and modifier 25 payment reduction policies.  The AADA also indicates its full support of CMS’ proposal to reduce the Physician Quality Reporting System (PQRS) requirements of 6 measures down from the current program policy of 9 measures.  In addition, the AADA appreciates that CMS proposed to accept our recommendation to reduce the maximum Value Modifier penalty in 2018 from 4% to 2%.

Click here to read AADA comments on the proposed rule.  The final 2018 Fee Schedule rule is expected to be released in November. 


CMS releases proposed 2018 Medicare Fee Schedule

July 13, 2017

The Centers for Medicare and Medicaid Services (CMS) today released the proposed 2018 Medicare Fee Schedule. Read the AADA breaking news alert with more information. AADA staff continues to analyze the rule, will be publishing other analyses, and plans to submit comments to CMS by September 11, 2017.


AADA sends advocacy positions and priorities to Senate Finance Chairman

May 23, 2017

In response to a request from Senator Orrin Hatch (R-UT), Chair of the Senate Finance Committee, for comments on the American Health Care Act (AHCA) and the Affordable Care Act (ACA), the AADA has sent a letter highlighting the Academy's advocacy positions and priorities.  This letter also includes a copy of the AADA's Health System Reform Principles.  Click here to read the letter.


2017 Medicare Physician Fee Schedule released

November 2, 2016
CMS released the 2017 Medicare Physician Fee Schedule Final Rule Nov. 2, 2016. While providing overall a 0% increase in dermatology payments, the fee schedule also contains important developments for dermatology, such as a modified reporting burden on global periods. Learn more about the final fee schedule.


CMS announces new MACRA physician payment rule

October 14, 2016
The new MACRA rule takes effect Jan. 1, 2017, with “ramp up” time for physicians who wish to participate; participating physicians could see as much as + 4% bonus payment in 2019. Read more.


AAD comments on 2017 Fee Schedule

August 30, 2016
The Academy submitted comments to CMS on the proposed 2017 Medicare Fee Schedule. Read the letter.


Dermatology to see 1 percent payment increase from Medicare in 2017 under proposed rule

July 7, 2016
The Centers for Medicare and Medicaid Services (CMS) released the proposed 2017 Medicare Physician Fee Schedule. While the overall impact of the proposed rule is a 1 percent increase in payments for dermatology, the American Academy of Dermatology Association is assessing the impact of several elements of the rule, including two related to global periods. Read more.

For a detailed summary of the rule, go to www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-07-07-2.html.

In a separate proposed rule, CMS indicated that it will reduce the reporting period for meaningful use of electronic health records in 2016 from a full year to 90 days. The AADA advocated strongly for this change.


Academy calls for MACRA delay, expansion of exception criteria

June 28, 2016
The comment period requesting feedback on CMS’s Medicare Access and CHIP Reauthorization (MACRA) proposed rule has come to a close. CMS received a deluge of comments from the medical community, including the AADA. In its comment letter, the AADA is requesting that CMS delay implementation of the MACRA rule from Jan. 1, 2017, to Jan. 1, 2018. The proposed rule outlines sweeping changes to Medicare payments and quality reporting — instituting two Medicare participation tracks: the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model program. The proposed rule stems from provisions required in the MACRA law that repealed and replaced the sustainable growth rate formula in 2015. The final rule is expected to be released in November 2016.

Specifically, the Academy requested that CMS modify the low-volume threshold — that would exempt physicians from participating in MACRA — to those whose Medicare billing charges are $75,000 or less and provide care for 750 or fewer Part B-enrolled Medicare beneficiaries, as opposed to $10,000 or 100 patients per physician. Additionally, the AADA asked CMS to shorten the reporting period from one year to three months and reduce the reporting requirement from 80 percent of MIPS eligible clinicians’ patients to 50 percent. Read more from the AADA’s comment letter. Find out more about how the proposed rule will affect your practice in the May 4 issue of Dermatology World Weekly.


Projected Medicare expenditures for 2017 will not trigger IPAB action

June 28, 2016
According to a report released by Medicare’s trustees, Medicare’s trust fund will remain solvent until 2028. The report also noted that based on the projected spending levels for Medicare in 2016, the five-year average growth in spending will not exceed the level that would trigger the need for the Independent Payment Advisory Board (IPAB) to make recommendations on reducing Medicare expenditures. The IPAB, created under the Affordable Care Act (ACA), is tasked with containing Medicare costs if they exceed certain levels. No members have been appointed and spending has not yet exceeded the target at which recommendations would be required.

The IPAB is not the only piece of the ACA that has affected patients and physicians. The development of the health insurance marketplace has increased the number of insured patients — but the newly insured often have high-deductible plans. Read more about getting paid in the age of high deductibles in Dermatology World.