G.N. Nicola

Component coding and the neurointerventionalist: a tale with an end

Component coding is the method NeuroInterventionalists have used for the past 20 years to bill procedural care. The term refers to separate billing for each discrete aspect of a surgical or interventional procedure, and has typically allowed billing the procedural activity, such as catheterization of vessels, separately from the diagnostic evaluation of radiographic images. This work is captured by supervision and interpretation codes. Benefits of component coding will be reviewed in this article. The American Medical Association/Specialty Society Relative Value Scale Update Committee has been filtering for codes that are frequently reported together. NeuroInterventional procedures are going to be caught in this filter as our codes are often reported simultaneously as for example routinely occurs when procedural codes are coupled to those for supervision and interpretation. Unfortunately, history has shown that when bundled codes have been reviewed at the RUC, there has been a trend to lower overall RVU value for the combined service compared with the sum of the values of the separate services.

Sustainable Growth Rate Repealed, MACRA Revealed: Historical Context and Analysis of Recent Changes in Medicare Physician Payment Methodologies

APM : Alternative Payment Models CHIP : Childrens Health Insurance Program CMS : Centers for Medicare and Medicaid Services MACRA : Medicare Access and CHIP Reauthorization Act of 2015 MIPS : Merit-Based Incentive Payment System SGR : Sustainable Growth Rate Intended to provide long-

PQRS and the MACRA: Value-Based Payments Have Moved from Concept to Reality

From its beginnings in 1965, Medicare costs quickly exceeded initial projections, prompting policy makers to enact a number of remedies during the history of the program. The most recent example is the Medicare Access and Childrens Health Insurance Program (CHIP) Reauthorization Act of 2015 (MACRA

Current Procedural Terminology: History, Structure, and Relationship to Valuation for the Neuroradiologist

SUMMARY: The year 1965 was critical for US health care policy. In that year, Medicare was created as part of the Social Security Act under President Lyndon B. Johnson after several earlier attempts by Presidents Franklin Roosevelt and Harry Truman. In 1966, the American Medical Association first published a set of standard terms and descriptors to document medical procedures, known as Current Procedural Terminology, or CPT. Fifty years later, though providers have certainly heard the term “CPT code,” most would benefit from an enhanced understanding of the historical basis, current structure, and relationship to valuation of Current Procedural Terminology. This article will highlight this evolution, particularly as it relates to neuroradiology.

Myelography CPT Coding Updates: Effects of 4 New Codes and Unintended Consequences.

SUMMARY: The Current Procedural Terminology of the American Medical Association has recently introduced coding changes for myelography with the introduction of new bundled codes. The aim of this review was to help neuroradiologists understand these code changes and their unintended consequences and to discuss various scenarios in which permutations of various codes could occur in clinical practice.

The Qualified Clinical Data Registry: A Pathway to Success within MACRA

ACR : American College of Radiology CMS : Centers for Medicare & Medicaid Services MACRA : Medicare Access and CHIP Reauthorization Act MIPS : Merit-based Incentive Payment System NRDR : National Radiology Data Registry PQRS : Physician Quality Reporting System QCDR : Qualified

Contextualizing the first-round failure of the AHCA: Down but not out

On 8 November 2016 the American electorate voted Donald Trump into the Presidency and a majority of Republicans into both houses of Congress. Since many Republicans ran for elected office on the promise to ‘repeal and replace’ Obamacare, this election result came with an expectation that campaign rhetoric would result in legislative action on healthcare. The American Health Care Act (AHCA) represented the Republican effort to repeal and replace the Affordable Care Act (ACA). Key elements of the AHCA included modifications of Medicaid expansion, repeal of the individual mandate, replacement of ACA subsidies with tax credits, and a broadening of the opportunity to use healthcare savings accounts. Details of the bill and the political issues which ultimately impeded its passage are discussed here.

ICD-10: History and Context

SUMMARY: In recent months, organized medicine has been consumed by the anticipated transition to the 10th iteration of the International Classification of Disease system. Implementation has come and gone without the disruptive effects predicted by many. Despite the fundamental role the International Classification of Disease system plays in health care delivery and payment policy, few neuroradiologists are familiar with the history of its implementation and implications beyond coding for diseases.

AHCA meets BCRA; timeline, context, and future directions

This past decade has brought important change to the delivery of healthcare in the United States. In 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (PPACA, also referred to as ACA or Obamacare) into law.1 The ACA sought to provide insurance for millions of additional Americans while simultaneously bending the cost curve down.2 Beyond that, the far-ranging law imposed new taxes, developed new independent agencies with heightened power in shaping healthcare policy and regulations, and advanced the implementation of accountable care.3–5 In response to the Congressional vote passing the ACA along strict party lines, Republicans have repeatedly emphasized their desire to undo the legislation and replace it with something they considered better. The Republican Congress subsequently undertook multiple votes to repeal the ACA throughout the remainder of the Obama administration. Nonetheless, even if successful in passing Congress, all such efforts were guaranteed to be vetoed by the President. In January 2015, Secretary of Health and Human Services Sylvia Burwell described the administration’s priority of transitioning volume-based care to a system providing greater value,6 7 and a whole new industry was formed to manage this transition.8 9 Throughout this period, a legion of other regulatory issues was confronting healthcare practitioners, ranging from ICD-10 implementation to meaningful use.10 One such perennial issue was the need to implement a fix to prevent enormous cuts to Medicare payments resulting from the sustainable growth rate formula for Part B services.11 12 In April 2015, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was passed, permanently ending the sustainable growth rate.13 14 However, MACRA, which has been described in numerous dedicated reviews,15 16 introduced an array of new challenges for providers, beneficiaries, and payers alike.17 18 It is generally agreed …

The Independent Payment Advisory Board

IPAB : Independent Payment Advisory Board ACA : Patient Protection and Affordable Care Act PCORI : Patient Centered Outcomes Research Institute MedPAC : Medicare Payment Advisory Commission The Independent Payment Advisory Board (IPAB) is considered the most potent cost-cutting measure of