THURSDAY | AUGUST 6, 2020
CMS Announces 2021 Physician Fee Schedules and Other Important Updates
 
 
ASIPP would like to share multiple news from the President, and CMS covering the following issues: 
 
  1. Executive order expanding telehealth benefits permanently for Medicare beneficiaries beyond the COVID-19 public health emergency.
  2. CMS physician payment proposed rule for 2021
  3. ASC and HOPD proposed payment rates for 2021
 
"First, on behalf of ASIPP board and the entire membership and chronic pain patients across the nation, we want to acknowledge all the interest President Trump has shown and hard work that Administrator Seema Verma, Secretary Azar, and the staff at HHS and CMS have done throughout he extraordinary challenges of the 2020 COVID-19 pandemic, and also for working with the interventional pain management community to assure the patients can still get the care they require," said Laxmaiah Manchikanti, MD, Chairman of the Board and Chief Executive Officer of ASIPP and SIPMS.
 
1.  PRESIDENT TRUMP'S EXECUTIVE ORDER TO EXPAND TELEHEALTH BENEFITS PERMANENTLY
 
The President proposed the executive rule in advance of the CMS announcements on August 4, 2020, improving convenience and care for Medicare beneficiaries, particularly those living in rural areas. The executive order will expand telehealth benefits permanent for Medicare beneficiaries beyond the COVID-19 public health emergency and advances access to care in rural areas.
 
CMS states that they are considering whether these policies should be extended on a temporary basis (that is, if the Public Health Emergency (PHE)) ends in 2021. These policies could be extended to December 31, 2021 to allow for a transition period before reverting to status quo policy or be made permanent. CMS is soliciting public comments on whether these policies should continue once the PHE ends.
 
The issue for interventional pain physicians, which ASIPP has been working tirelessly, is answered with the same payments as if patients were seen inside the hospital with telephone only codes as follows:
 
CPT 99441 - phone only, 5-10 minutes           $54.20
CPT 99442 - phone only, 11-20 minutes          $87.10
CPT 99443 - phone only, 21-30 minutes          $123.56
 
Once again, this is a national rate.
 
2. PHYSICIAN FEE SCHEDULE FOR CALENDAR YEAR 2021
 
CMS has released proposed policy changes to the Medicare physician fee schedule for calender year 2021 on August 3, 2020 at midnight (https://s3.amazonaws.com/public-inspection.federalregister.gov/2020-17127.pdf). CMS claims that the calender year 2021 PFS proposed rule is one of several proposed rules that reflect a broader administration - wide strategy to create a health care system that results in better accessibility, quality, affordability, empowerment, and innovation.
 
For interventional pain management programs for interventional pain management physicians, an overall picture shows that there is a 7% combined impact in reference to the charges by specialty, while many of the other specialties have shown decreases. A few specialties like endocrinology, family practices, general practices, and internal medicine have shown increases.
 
Consequently, multiple surgical specialists are extremely upset about this payment rule; however, for interventional pain physicians, it has not been that bad.
 
ASIPP has calculated the proposed preliminary physician payment rates compared to 2020.
 
Overall physician payment rates have shown declines, specifically, more commonly utilized procedures when performed in a facility setting, meaning ASC or hospital. The cuts are much less when performed in an office setting (non-facility setting). The schedule shows these payments:  http://www.asipp.org/Fee%20Schedules/2021PhyPro.pdf
 
Physician payment rule specifically deals with payment updates with reduction in the conversion factor for 2021 of $32.26, down from $36.09 in 2020.
 
The major reductions are based on the reconfiguration of CPT codes for evaluation and management services with increased payments, but based on time rather than components. The average increase in work RVU values is 8% or 0.17 work RVUs, for new patient codes and 28% or 0.33 work RVUs, for established patient visit codes.
 
 
CMS is required to keep the PFS budget neutral, which means that increasing the work RVU values for these 9 codes would require CMS to decrease work RVU values for other CPT codes, reduce the conversion factor, or some combination of both.
 
CMS announced in the calendar year 2020 Medicare Physician Fee Schedule (PFS) final rule that it would implement changes to office visit Evaluation and Management codes for the 2021 calendar year.
 
The expected 2021 PFS changes include documentation and code selection updates and updates to work RVU (wRVU) values. This alert will focus on the wRVU value updates that affect code ranges 99201 to 99205 (new patient visit codes) and 99211 to 99215 (established patient visit codes).
 
2.1 Evaluation and Management Services
 
CMS announced its plan to remove code 99201 from the new patient visit code range increase the wRVU values for the remaining new patient and established patient visit codes as outlined in the tables below:
 
2021 Physician Proposed Payment Rates for E/M Services
See Table Below
 
The average increase in wRVU values is 8 percent, or 0.17 wRVUs, for new patient codes and 28 percent, or 0.33 wRVUs, for established patient visit codes.
 
CMS is required to keep the PFS budget neutral, which means that increasing the wRVU values for these nine codes would require CMS to decrease wRVU values for other CPT codes, reduce the conversion factor, or some combination of both.
 
2.2 Telehealth
 
CMS proposed several services to the Medicare telehealth services list during the public health emergency for the COVID-19 pandemic, including home visits for established patients and psychological and neuropsychological testing.
 
One of the expansions which ASIPP has worked tirelessly was telephone only. We are grateful to CMS that they retained not only the codes, but also the payment rates as if a patient was seen in the office.
 
3. AMBULATORY SURGERY CENTER AND HOPD RULE
 
CMS has released the 2021 proposed payment rule for ASCs and HOPDs today. Overall, ASCs received inflation update factor of 3% similar to HOPDs, whereas conversion factor remains $48.984 for ASCs compared to $83.697 for HOPD.
 
 
Multiple codes have been added; however, none of these are related to interventional pain management.
 
This rule published provides us with proposed payment rates for 2021 for ASCs, as well as hospitals. We will focus on ASCs as of now, in the future we will publish hospital rates too. As shown in the links below, there have been some increases to majority of the codes.
 
 
Some of the codes with major abnormalities are intercostal nerve blocks (first level) and intercostal nerve block add-on codes (the definition was changed last year), but CMS continues to follow the old philosophy. It also raises the doubts: Did CMS ask for the revision of the codes or did someone ask the AMA to change these codes? Consequently, reimbursement levels for these still appear to be inappropriate. Further, reimbursement for genicular nerve blocks and genicular nerve radiofrequency also seem to be still inadequate and inaccurate.

ASIPP® Annual Meeting 2020 Goes Virtual
 
Due to unavoidable circumstances related to COVID-19, ASIPP is transitioning its annual meeting scheduled September 4-6, 2020, in Dallas, Texas to a virtual meeting. This will provide you with many advantages:
 
  • Save time and money: More time in the office with patients and no fear of Covid exposure.
  • Attend the meeting from wherever you want.
  • Get back on track with your CMEs.
  • Revisit the sessions and explore exhibit booths even after the meeting ends. Virtual platform access will remain open until the summer of 2021.
  • Same great networking opportunities in virtual platform: Ability to host and request private meetings; talk with others while you visit exhibit booths, and so much more!
  • Still offering world-renowned speakers on relevant subjects to IPM, COVID-19 interfacing with IPM, and many other subjects including opioids and regenerative medicine.
  • Meeting kicks off with a presentation by a well-known figure in the industry, Randy Alvarez, President and CEO of Wellness Hour.
 
 
If you have already registered for the Annual Meeting, your registration fee has been transferred to the Virtual Annual Meeting. There is nothing you need to do now. You will receive information on how to attend the meeting in August.
 




Order Now - Recorded Virtual Review Courses


The following courses are offered:


  • Documentation, Coding, Compliance, and Practice Management Review Course
  • Controlled Substance Management Review Course
  • *Pain Medicine and Interventional Pain Management Comprehensive Review Course

*not available until the end of the live course July 26, 2020
ABIPP Recognizes Your Knowledge and Expertise
 
The American Board of Interventional Pain Physicians (ABIPP) has developed certification programs that recognize accepted levels of knowledge and expertise in the interventional pain management profession, with the goal of improved patient care. Hundreds of qualified physicians have made the commitment to become ABIPP certified.
 
ABIPP now offers the only competency
certification program for regenerative medicine.

For complete information about the examination requirements and to obtain an application packet, visit www.abipp.org or call 270-554-9412 x4217 or by email at summer@asipp.org.

TESTS OFFERED
 
ABIPP Part I - Theoretical written exam - TBD
 
ABIPP Part II - Oral and Hands-on practical exam - TBD
 
ABIPP Competency Exam - includes written, oral, and hands-on practical examinations TBD
 
Combined CSM/CCPM Exam for ABIPP Path – TBD
 
Competency Exam in Controlled Substance ManagementTBD
 
Competency Exam in Coding, Compliance, and Practice Management TBD
 
Regenerative Medicine Competency Exam - includes written, oral, and hands-on practical examinations – TBD
NIH clinical trial testing remdesivir plus interferon beta-1a for COVID-19 treatment begins

A randomized, controlled clinical trial evaluating the safety and efficacy of a treatment regimen consisting of the antiviral remdesivir plus the immunomodulator interferon beta-1a in patients with coronavirus disease 2019 (COVID-19) has begun. The study, called the Adaptive COVID-19 Treatment Trial 3 (ACTT 3), is anticipated to enroll more than 1,000 hospitalized adults with COVID-19 at as many as 100 sites in the United States and abroad. The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, is sponsoring the trial.

ACTT 3 is the third iteration of NIAID’s Adaptive COVID-19 Treatment Trial (ACTT). ACTT began on Feb. 21 to evaluate remdesivir, an investigational broad-spectrum antiviral discovered and developed by Gilead Sciences, Inc, of Foster City, California. A preliminary analysis of ACTT data found that patients who received remdesivir had a statistically significant shorter time to recovery compared to patients who received placebo. These results were published on May 22. More detailed information about the results, including more comprehensive data, will be available in a forthcoming report.


READ MORE | NIH |
The U.S. has the worst coronavirus outbreak in the world: ‘The numbers don’t lie,’ Dr. Fauci says

White House coronavirus advisor Dr. Anthony Fauci agreed on Wednesday that the United States has the worst coronavirus outbreak in the world, pointing to the nation’s high number of Covid-19 infections and deaths. 

“Yeah, it is quantitatively if you look at it, it is. I mean the numbers don’t lie,” Fauci said when asked during an interview with CNN’s Dr. Sanjay Gupta whether the U.S. had the world’s worst coronavirus outbreak.

The U.S., which accounts for less than 5% of the world population, leads all other countries in global coronavirus infections and deaths. The nation represents more than 22% of global coronavirus deaths and more than 25% of infections as of Wednesday, according to Johns Hopkins University data.

READ MORE | CNBC |
July/August 2020
Issue Available
In this issue, Pain Physician includes Systematic Reviews on Interlaminar Epidural Injections, the Scrambler Therapy, and Long-term Outcomes of Epidurals for Lumbar Disc Hernation; Randomized Trials on Bilateral Ultrasound-Guided Erector Spine Plane Block and Contrast Medium Volume needed for Transforaminal Epidural Injections, and more.
COVID-19 Event Risk Assessment Planning Tool

Because you can’t see the coronavirus and many infected with it show no symptoms, it can be difficult to grasp how risky a certain situation is. But a new online tool is making that calculation a bit easier for people in the Bay Area and beyond.

The interactive map, developed by professors at Georgia Tech, lets people explore the odds that coronavirus will be present at an event anywhere in the U.S., depending on the event’s size and the county in which it’s located. The map calculates the likelihood of whether each gathering would include someone who is currently infectious.
The risk level is the estimated chance (0-100%) that at least 1 COVID-19 positive individual will be present at an event in a county, given the size of the event.
Based on seroprevalence data, we assume there are ten times more cases than are being reported (10:1 ascertainment bias). In places with more testing availability, that rate may be lower.


CDC: Don't Overlook Kids' AFM Symptoms in the Middle of COVID
— Early reporting, follow-up critical as season for mysterious paralytic syndrome approaches

The every-other-year acute flaccid myelitis (AFM) outbreak in children looks to become even more complicated during the COVID-19 pandemic, and early reporting and follow-up by healthcare providers is critical, the CDC said on Tuesday.

"This could be another outbreak for clinicians, parents and children to deal with," on top of flu, the COVID-19 pandemic, and other respiratory illnesses, said CDC Director Robert Redfield, MD, on a conference call with reporters.


READ MORE | MEDPAGE TODAY |
ASIPP® Partners with Fedora Billing And Revenue Cycle Management Company 
ASIPP is now able to offer unique benefits for revenue cycle management with billing, etc.

Fedora is a company known to many of our board members and others. ASIPP® has reached an agreement with Fedora to provide exclusive discounts on billing or revenue cycle management that will decrease practice costs and promote growth, or at least stop deterioration. It is not just a billing company; they streamline the billing and receivable process and constantly update payor regulations keeping your practice up to on date on a daily basis. 

You may view the ASIPP® billing program website at the following link: https://www.asippbilling.com/ 

Some of the ASIPP® Billing Program highlights are below:
Up to 50% savings for ASIPP® members for their billing or revenue cycle management for their offices and surgery centers:
 
  • Expertise in interventional pain management billing for all types of services
  • 99% Clearing House Rate
  • 95% First-Time Claim Passage
  • 23.4 Average Days in A/R
  • Eligibility and Benefits Verification 
  • Pre-Certification/Prior Authorization
  • Denials and A/R Management 

VIEW THE ASIPP® BILLING PROGRAM | CLICK HERE |
Join The Group Purchasing
Organization Today
ASIPP® has formed a partnership with Henry Schein and PedsPal, a national GPO that has a successful history of negotiating better prices on medical supplies and creating value added services for the independent physician. Working with MedAssets, PedsPal provides excellent pricing on products like contrast media that alleviate some of the financial pressures you experience today. While the cost of contrast media has skyrocketed due to the single dose vial issue, because we have partnered with Henry Schein, this could enable you to purchase Omnipaque 240mg/50mL for slightly above $4.50.

It will be easy for ASIPP® members in good standing to enroll today and begin to realize the savings this partnership can bring. Members can join or see sample prices by going to  https://pedspal.org/Pages/default.aspx

Click on “view our discounted supplier prices” (Username: ASIPPmember and Password: Save) or click on the words "join for free now" and begin saving today!

LEARN MORE ABOUT GROUP PURCHASING | CLICK HERE |
Skin Rashes a Clue to COVID-19 Vascular Disease
— Certain skin manifestations tied to coagulopathy in the sickest patients

Certain types of rashes in severe COVID-19 patients may be "a clinical clue" to an underlying thrombotic state, researchers said.

Four patients with severe illness at two New York City academic medical centers had livedoid and purpuric rashes, all associated with elevated D-dimer levels and suspected pulmonary emboli, reported Joanna Harp, MD, of NewYork-Presbyterian/Weill Cornell Medical College in New York City, and colleagues, writing in a research letter in JAMA Dermatology.

All had been on prophylactic anticoagulation since admission and developed those "hallmark manifestations of cutaneous thrombosis" despite escalation to therapeutic dose anticoagulation for the suspected pulmonary embolism before the rash was noted.


READ MORE | MEDPAGE TODAY |
HHS, DOD Collaborate With Johnson & Johnson to Produce Millions of COVID-19 Investigational Vaccine Doses

The U.S. Department of Health and Human Services (HHS) and Department of Defense (DoD) announced an agreement with the Janssen Pharmaceutical Companies of Johnson & Johnson, to demonstrate large-scale manufacturing and delivery of the company's COVID-19 vaccine candidate. Under the terms of the agreement, the federal government will own the resulting 100 million doses of vaccine.

The vaccine doses could be used in clinical trials or, if the U.S. Food and Drug Administration (FDA) authorizes use as outlined in agency guidance, the doses would be distributed as part of a COVID-19 vaccination campaign.

"With the portfolio of vaccines being assembled for Operation Warp Speed, the Trump Administration is increasing the likelihood that the United States will have at least one safe, effective vaccine by 2021," said HHS Secretary Alex Azar. "Today's investment represents the next step in supporting Janssen's vaccine candidate all the way through manufacturing, with the potential to bring hundreds of millions of safe and effective doses to the American people."


READ MORE | HHS |
Essentials of Regenerative Medicine in Interventional
Pain Management
Essentials of Regenerative Medicine in Interventional Pain Management is a book to bring concise, collective, and comprehensive information to interventional pain physicians practicing regenerative medicine in managing chronic pain. Regenerative medicine is an integral part of interventional pain management within the definitions of interventional pain management and interventional techniques.

Each chapter contains an introduction of the subject, historical context,pathophysiology, applicability of regenerative medicine with its evidence base, indications, anatomy, technical aspects, complications, and precautions for each topic when available and applicable. This comprehensive book consists of 35 chapters, more than 350 figures, and 50 tables.
| ORDER | Essentials of Regenerative Medicine in IPM
Control Your Waiting Room TV

Customized waiting room TV exclusively for ASIPP® members. Create your own ad-free television broadcasts using our videos, custom informational slides and your own YouTube videos. Even add local weather reports, news and live messages.
GET YOUR OWN LOBBY TV CHANNEL | CLICK HERE FOR ASIPP-TV |
STATE SOCIETY MEETINGS
Send in your state society meeting news to Holly Long, hlong@asipp.org
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