Health Policy By the Numbers: A Snapshot of Early 2013
2013 has proven to be yet another busy year for the Academy’s Health Policy team as we continue to work with federal regulatory agencies, private payers, consumer advocate groups, patients, and providers to ensure Academy members receive the best representation and advocacy for our specialty possible. Here is a snapshot, by the numbers, of how the Academy’s Health Policy department has advocated on behalf of members thus far in 2013. 3: The number of fact sheets created by the Health Policy and Research and Quality Improvement departments to inform members and aid in their participation in the Physician Quality Reporting System (PQRS), Electronic Health Record (EHR) Meaningful Use (MU) Incentive Program and the Electronic Prescribing (eRx) Incentive Program. These sheets and other information can be found on the Academy’s website at www.entnet.org/cmspenalties. 135 (as of May 14): The number of member inquiries the Health Policy department has responded to. Every day, members from across the country contact the Health Policy staff with questions ranging from private payer denials and appeals, questions and requests for resources for Quality Reporting Programs such as PQRS and EHR Incentive Programs http://www.entnet.org/Practice/CMSpenalties.cfm, information on changes to CPT coding requirements or newly developed CPT codes http://www.entnet.org/Practice/CPT-Codes-for-2013.cfm, and tools to aid in the upcoming ICD-10 transitionhttp://www.entnet.org/Practice/International-Classification-of-Diseases-ICD.cfm. Health Policy staff work to assist members on a wide variety of issues by providing up-to-date resources and expert analysis. We urge members to contact us with any health policy inquiries at healthpolicy@entnet.org. 16: The number of Bulletin articles developed by the Physician Payment Policy (3P) Workgroup and Health Policy staff from January2013 – May 2013. Articles included summaries of 2013 physician payment rules, CPT coding guidance, and work the Academy is undertaking on current, and future, payment models and trends in otolaryngology. 7: The number of physician leaders serving on the Academy Ad Hoc Payment Model Workgroup which includes members of the Physician Payment Policy work group (3P) and research and quality leaders. This Ad Hoc group reviews the current and future payment trends in otolaryngology-head and neck surgery with the goal of preparing our leaders to be able to respond to new payment models as they are developed by government and commercial insurers. Members of the Ad Hoc workgroup have recently begun reviewing some potential bundled payment and episode of care models. 2: The number of miniseminars 3P and Health Policy staff will be presenting at the 2013 AAO-HNSF Annual Meeting & Oto Expo in Vancouver, BC, Canada from September 29 to October 2, 2013. Two sessions, titled “Alternative Payment Models & Academy Advocacy” and “Pearls on How to Transition to ICD-10 Coding by 2014” will feature advice from Academy and outside experts on the future of healthcare payment and provider transition to the ICD-10 coding system. 16: The number of Academy Position Statements reviewed in Round 2 by Academy clinical committees. Position Statements serve the following functions: a response to payer policies; a way to publicize our position or support a procedure; for use in advocacy efforts with state and federal regulatory bodies, in response to federal policy or law; or to clarify the Academy’s position on certain practices within the specialty. They are reviewed every four years to ensure the statements are up to date and useful for members. The Academy’s position statements can be accessed at: http://www.entnet.org/Practice/Position-Statements.cfm 6: The number of CPT codes surveyed by the Academy in 2013 for the January and April AMA Specialty Society Relative Value Scale Update Committee (RUC) meeting. In January, CPT 69210 removal impacted cerumen and new code CPT 6461XX chemodenervation of the larynx were presented to the RUC. In April, the Nasal/Sinus Endoscopy family of codes (31237-31240) were surveyed and data was presented to the RUC during the April, 2013 RUC meeting. Members are encouraged to keep an eye out for future solicitations for participation in RUC surveys, as they are an important tool used to establish Medicare reimbursement for otolaryngology services. To access more information regarding the RUC survey process, visit: http://www.entnet.org/Practice/Applying-for-CPT-codes-and-Obtaining-RVU.cfm. 7: The number of private payer policies the Academy coordinated review of and submitted comments on. These include United HealthCare and Aetna’s Septoplasty and Rhinoplasty coverage policies, United HealthGroups: Direct-to-Consumers (DTC) hearing aid sales program, and WellPoint/BCBS Sinus Ostial Balloon Dilation Policy. You can access resources to help you with the Academy’s Private Payer Advocacy at http://www.entnet.org/Practice/pmNews.cfm. 2: Number of new or revised CPT for ENT articles distributed and posted on the website for Members. For more information on Academy coding guidance visit: http://www.entnet.org/Practice/cptENT.cfm. 1: Number of in-person meetings the Academy Health Policy and Research, Quality Improvement staff has convened with CMS to discuss clinical quality measures and the need for more specific measures related to our specialty to enable members to meaningfully participate in quality programs such as PQRS and the EHR Incentive program.
2013 has proven to be yet another busy year for the Academy’s Health Policy team as we continue to work with federal regulatory agencies, private payers, consumer advocate groups, patients, and providers to ensure Academy members receive the best representation and advocacy for our specialty possible. Here is a snapshot, by the numbers, of how the Academy’s Health Policy department has advocated on behalf of members thus far in 2013.
3: The number of fact sheets created by the Health Policy and Research and Quality Improvement departments to inform members and aid in their participation in the Physician Quality Reporting System (PQRS), Electronic Health Record (EHR) Meaningful Use (MU) Incentive Program and the Electronic Prescribing (eRx) Incentive Program. These sheets and other information can be found on the Academy’s website at www.entnet.org/cmspenalties.
135 (as of May 14): The number of member inquiries the Health Policy department has responded to. Every day, members from across the country contact the Health Policy staff with questions ranging from private payer denials and appeals, questions and requests for resources for Quality Reporting Programs such as PQRS and EHR Incentive Programs http://www.entnet.org/Practice/CMSpenalties.cfm, information on changes to CPT coding requirements or newly developed CPT codes http://www.entnet.org/Practice/CPT-Codes-for-2013.cfm, and tools to aid in the upcoming ICD-10 transitionhttp://www.entnet.org/Practice/International-Classification-of-Diseases-ICD.cfm. Health Policy staff work to assist members on a wide variety of issues by providing up-to-date resources and expert analysis. We urge members to contact us with any health policy inquiries at healthpolicy@entnet.org.
16: The number of Bulletin articles developed by the Physician Payment Policy (3P) Workgroup and Health Policy staff from January2013 – May 2013. Articles included summaries of 2013 physician payment rules, CPT coding guidance, and work the Academy is undertaking on current, and future, payment models and trends in otolaryngology.
7: The number of physician leaders serving on the Academy Ad Hoc Payment Model Workgroup which includes members of the Physician Payment Policy work group (3P) and research and quality leaders. This Ad Hoc group reviews the current and future payment trends in otolaryngology-head and neck surgery with the goal of preparing our leaders to be able to respond to new payment models as they are developed by government and commercial insurers. Members of the Ad Hoc workgroup have recently begun reviewing some potential bundled payment and episode of care models.
2: The number of miniseminars 3P and Health Policy staff will be presenting at the 2013 AAO-HNSF Annual Meeting & Oto Expo in Vancouver, BC, Canada from September 29 to October 2, 2013. Two sessions, titled “Alternative Payment Models & Academy Advocacy” and “Pearls on How to Transition to ICD-10 Coding by 2014” will feature advice from Academy and outside experts on the future of healthcare payment and provider transition to the ICD-10 coding system.
16: The number of Academy Position Statements reviewed in Round 2 by Academy clinical committees. Position Statements serve the following functions: a response to payer policies; a way to publicize our position or support a procedure; for use in advocacy efforts with state and federal regulatory bodies, in response to federal policy or law; or to clarify the Academy’s position on certain practices within the specialty. They are reviewed every four years to ensure the statements are up to date and useful for members. The Academy’s position statements can be accessed at: http://www.entnet.org/Practice/Position-Statements.cfm
6: The number of CPT codes surveyed by the Academy in 2013 for the January and April AMA Specialty Society Relative Value Scale Update Committee (RUC) meeting. In January, CPT 69210 removal impacted cerumen and new code CPT 6461XX chemodenervation of the larynx were presented to the RUC. In April, the Nasal/Sinus Endoscopy family of codes (31237-31240) were surveyed and data was presented to the RUC during the April, 2013 RUC meeting. Members are encouraged to keep an eye out for future solicitations for participation in RUC surveys, as they are an important tool used to establish Medicare reimbursement for otolaryngology services. To access more information regarding the RUC survey process, visit: http://www.entnet.org/Practice/Applying-for-CPT-codes-and-Obtaining-RVU.cfm.
7: The number of private payer policies the Academy coordinated review of and submitted comments on. These include United HealthCare and Aetna’s Septoplasty and Rhinoplasty coverage policies, United HealthGroups: Direct-to-Consumers (DTC) hearing aid sales program, and WellPoint/BCBS Sinus Ostial Balloon Dilation Policy. You can access resources to help you with the Academy’s Private Payer Advocacy at http://www.entnet.org/Practice/pmNews.cfm.
2: Number of new or revised CPT for ENT articles distributed and posted on the website for Members. For more information on Academy coding guidance visit: http://www.entnet.org/Practice/cptENT.cfm.
1: Number of in-person meetings the Academy Health Policy and Research, Quality Improvement staff has convened with CMS to discuss clinical quality measures and the need for more specific measures related to our specialty to enable members to meaningfully participate in quality programs such as PQRS and the EHR Incentive program.
