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E-News: September 2019

#ASNR20: Now Accepting Abstract Submissions! AJNR News Digest: September-October 2019 Edition Shop With Purpose: The Foundation of the ASNR is on AmazonSmile!  The Foundation of the ASNR June/July Donors HPC Corner: CACs Are Not What Your Cat Coughs Up… Have you checked out Neurocurriculum Live lately? Specialty/Regional Society Annual Meetings

Submit your scientific research for presentation at the ASNR 58 th Annual Meeting! View the call for abstracts and submit abstracts by Friday, November 1, 2019.

In the September-October 2019 edition of AJNR ’s News Digest, compiled by Guest Editor Maria Vittoria Spampinato, 6 authors evaluate high-resolution vessel wall MR imaging and its emergence in recent years as the leading imaging modality for the visualization and characterization of the arterial vessel wall. To view the issue, click here .

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Discover a whole new way to support The Foundation of the ASNR with AmazonSmile! Now, every time you shop on Amazon, 0.5% of the price of your eligible purchases can be donated to The Foundation of the ASNR. AmazonSmile is the same Amazon you know: Same products, same prices, same service. Start shopping with these 3 easy steps: Support the Foundation of the ASNR and begin your shopping at https://smile.amazon.com/ch/36-4034440. Log in with your Amazon username and password. Select The Foundation of the American Society of Neuroradiology as your charity of choice.  Thank you for your continued support!

Thank You To The Foundation of the ASNR's Donors  June: Juan Pablo Cruz, MD July: Norman E. Leeds, MD

CACs Are Not What Your Cat Coughs Up… By: Sammy Chu, MD, FRCPC, FACR

…But they do impact your reimbursement. First, some background: As Medicare insures such a large number of individuals in the country, the federal government is not able to process all those claims, especially since the age 65+ segment is such a large user of health services. So CMS (the Centers for Medicare & Medicaid Services) bundles up the 50 states into 12 jurisdictions, and every few years, awards contracts for processing Medicare claims in a jurisdiction to private insurance companies in a bidding process. For example, Washington State, where I live, gets bundled with nine other Western states into Jurisdiction F, where Noridian is the Medicare Administrative Contractor (MAC). Fortunately, the MACs don’t get to do whatever they want. The federal government still oversees everything, and it sets regulations that MACs must follow. One of these regulations obliges each MAC to form a committee of physicians from each specialty in each state—the Contractor Advisory Committee (CAC). Until this year, the MAC was required to meet with each CAC three times a year. At these CAC meetings, physicians are given the opportunity to offer feedback on payment policies that each MAC puts forth, known as LCDs, or Local Coverage Determination policies. (Are those enough abbreviations for you?) Physicians are not be able to directly change the proposed policies at the CAC meetings, but at least each MAC will hear what we don’t like about the LCDs and what we REALLY don’t like about the LCDs.  However, at the beginning of this year, CMS put forth several changes to the CAC and LCD process that were mandated by the 21 st Century Cures Act. [1] , [2]  Many of the revisions improve the transparency of the LCD development process. One of these changed the purpose of the CAC from a review forum for a proposed LCD written by the MAC, to a discussion group analyzing the medical literature to help guide the MAC before it writes up an LCD. After gathering all the information, the MAC would then draft its policy, and publish the proposed LCD on Medicare’s website. The proposal would then be open to comment by the public, and the MAC would also be required to host an open meeting to discuss the rationale and scientific basis for the changes. At the end of a mandatory comment period, the MAC would need to respond (in writing) to all written comments and finalize its LCD. Another improvement is that any stakeholder (which includes physicians) can request that any finalized LCD be reconsidered. If the request is found to be valid, the MAC would be obligated to undergo the LCD development process outlined above. One change which is less welcome is a change in the format and frequency of the CAC meetings. Instead of mandatory meetings three times a year, “The MAC shall have the discretion to determine the frequency of the CAC meetings and shall base the meetings on the appropriateness and on the volume of LCDs that require CAC consultation as part of the LCD process.” 1  What the meetings previously allowed was not only the ability to discuss the proposed policies, but the opportunity to meet on a more personal basis with individuals at each MAC and to run ideas by them. There were usually other items on the agenda (e.g. list of most common causes for denials, audit issues) that were often discussed. I already know of one Contractor that has cancelled its remaining meetings for the year. What’s worse is that the MACs are now allowed to conduct a single-jurisdictional CAC, or even a multi-jurisdiction CAC, usually by teleconference. Earlier this year, several MACs had already teamed up to organize a single multi-jurisdictional CAC meeting discussing percutaneous vertebral augmentation (a.k.a. vertebroplasty and kyphoplasty). There were challenges in ensuring that all the CAC members in the jurisdictions involved received invitations to the meeting. Which is where you come in. More than ever, ASNR needs its members to be aware of payment issues and policy changes that are occurring locally, but may be affecting a much larger population. Ask questions, pass the word on to the ASNR Economics and Health Policy office, and if you can, get involved. Otherwise, you may very well be crying “CAC”! Sammy Chu, MD, FRCPC, FACR Radiology representative to WA State CAC @SammyChuMD1 [1] Centers for Medicare & Medicaid Services (CMS). CMS Manual System: Pub 100-08 Medicare Program Integrity. Transmittal 863. Change Request 10901. Downloaded from https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019Downloads/R863PI.pdf on August 27, 2019. [2] Centers for Medicare & Medicaid Services (CMS). MLN Matters: Local Coverage Determinations (LCDs). MLN Matters Number 10901 Revised. Downloaded from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10901.pdf on August 27, 2019.

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Specialty/Regional Society Annual Meetings

WNRS 51 st Annual Meeting September 26-29, 2019 Coeur d’ Alene Hotel Coeur d’ Alene, ID Register Now! View WNRS Website

ASHNR 53 rd Annual Meeting October 2-6, 2019 Westin Kierland Resort & Spa Scottsdale, AZ Register Now! View ASHNR Website

SENRS 43 rd Annual Meeting October 17-19, 2019 Villas of the Grand Cypress in Orlando, FL Register Now! View SENRS Website

ASFNR 13 th Annual Meeting November 3-5, 2019 San Francisco Hilton Financial District San Francisco, CA Register Now! View ASFNR Website

ASPNR 2 nd Annual Meeting  January 10-12, 2020 Eden Rock Miami, FL View ASPNR Website

ASSR 2020 Annual Symposium February 12-16, 2020 The Ritz-Carlton Laguna-Niguel Dana Point, CA View ASSR Website

ASNR 58 th Annual Meeting & The Foundation of the ASNR Symposium 2020 May 30 - June 4, 2020 Caesars Palace Las Vegas, NV View ASNR Meeting Page

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