Medicare

Action Alert: Congress Congress to Stop Medicare’s Surgical Cuts

August 19, 2020

  Medicare proposed musculoskeletal cuts of at least 5 percent in its 2021 Physician Fee Schedule proposed rule earlier this summer. All surgeons are encouraged to contact their members of Congress to co-sponsor HR 8702 to prevent the cuts by the end of the year. Click here to send an e-mail to ask your member…

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A Look at Medicare’s Competitive Bidding Program for DME

November 19, 2019

TOA recently sat down with Ross DeRogatis of Matrix Orthopedics to look at Medicare’s Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding program, which will affect back and knee braces. Ross is the President/Owner of Matrix Orthopedics, an exclusive Donjoy distributor.  He has been in the DME space for over 10 years and…

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Medicare’s CY 2020 OPPS/ASC Payment Proposal

August 2, 2019

The Centers for Medicare and Medicaid Services (CMS) released its proposed payment policy for the Medicare hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system for calendar year (CY) 2020 on July 29, 2019. Keep in mind that the American Association of Orthopaedic Surgeons (AAOS) is currently digging through the proposed…

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Medicare’s CY 2020 Physician Fee Schedule Proposal

August 2, 2019

The Centers for Medicare and Medicaid Services (CMS) released its proposal for the calendar year (CY) 2020 Physician Fee Schedule (PFS) on July 29, 2019. The American Association of Orthopaedic Surgeons (AAOS) will provide a lengthy summary of the proposal and a response in the near future. In the meantime, TOA has provided a summary…

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TOA Comments on Medicare’s Back and Knee Brace Proposal

December 18, 2018

The Texas Orthopaedic Association (TOA) submitted feedback on December 17, 2018 that expresses concern regarding the Centers for Medicare and Medicaid Services (CMS) proposal to add back and knee braces to Medicare’s new round of competitive bidding. TOA expressed concern that this could limit the number of physicians who would be able to provide these…

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Medicare Unveils Price Procedure Lookup Tool for ASCs and HOPDs

November 28, 2018

The Centers for Medicare and Medicaid Services (CMS) introduced the Price Procedure Lookup tool, which allows consumers to compare the prices of ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs), on November 27. The tool was created in January 2017 by the 21st Century Cures Act. Click here to learn more from CMS.

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TOA Update: Medicare Finalizes 2019 Physician Fee Schedule & ASC/HOPD Rules

November 5, 2018

The Centers for Medicare and Medicaid Services (CMS) released the final calendar year (CY) 2019 Physician Fee Schedule (PFS) rule on November 1, and CMS modified the controversial E/M proposal. CMS also released the hospital outpatient department (OPPS) and ambulatory surgery center (ASC) final payment policy rule for CY 2019 on November 2. Click here…

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Medicare Extends Site Neutral Policy in 2019 HOPD/ASC Payment Proposal; ASC Victories

July 26, 2018

A discussion related to approving hip and knee replacement surgeries for Medicare payment in ASCs dominated last year’s hospital outpatient department (HOPD) and ambulatory surgery center (ASC) payment proposal for Medicare. (Ultimately, CMS simply removed TKA from the inpatient only list.) The 2019 proposal, which was released on July 25, 2018, only addressed the anesthesia…

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TOA Urges Lawmakers to Contact Congress on BPCI Advanced/CJR Conflict

February 14, 2018

BPCI Advanced – Medicare’s new physician-led bundled payment program that was announced in January 2018 – will not allow orthopaedic surgeons located in Texas’ five Comprehensive Center for Joint Replacement (CJR) to lead their own bundles for lower extremity joint replacements in the new BPCI Advanced program. Due to the upcoming March 12, 2018 application…

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