ASC vs. HOPD - CMS rules
Question:
With the Medicare changes regarding prior auth requirements and frequency for basic procedures such as MBB, RFA, ESI, etc., quick question...
Is there any difference in performing these procedures in an ASC vs. HOPD facility?
The reason I ask is that I currently practice in HOPD facility, but have and opportunity to move my procedures to an nearby ASC. If that would help to avoid some of the CMS LCD requirement nonsense, it would be worth it!
Thoughts?
Thanks, (Source: Student Doctor Network)
Source: Student Doctor Network - January 23, 2024 Category: Universities & Medical Training Authors: MedZeppelin Tags: Pain Medicine Source Type: forums
Medicare advantage trap-
I wish more seniors were aware of this trap and that they can’t go back to regular Medicare.
Older Americans say they feel trapped in Medicare Advantage plans — NPR
As enrollment in Medicare Advantage plans grows, so do concerns about how well the insurance works, including from those who say they have become trapped in the private plans as their health declines.
apple.news (Source: Student Doctor Network)
Source: Student Doctor Network - January 7, 2024 Category: Universities & Medical Training Authors: bedrock Tags: Pain Medicine Source Type: forums
Re: Racial differences in low value care among older adult Medicare patients in US health systems: retrospective cohort study
(Source: BMJ Comments)
Source: BMJ Comments - December 2, 2023 Category: General Medicine Source Type: forums
More than one NPI …
Have a couple friends who have opted out out of Medicare/Medicaid and are doing some cash pay work, but ALSO work for 501c3 clinics where they treat Medicaid patients. The facilities were fine with it (them having already opted out of Medicare), and just took out another NPI in their name [emoji2369]
Is this legal?
I am not very well versed in this kind of stuff so I figured I would turn to my tried and true source for all things podiatry here at SDN.
I have another friend who has two NPI’s and...
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Source: Student Doctor Network - December 1, 2023 Category: Universities & Medical Training Authors: billBOB213 Tags: Podiatric Residents & Physicians Source Type: forums
Why the hell does Medicare not cover bupe?
Got this lovely message today, in regards to an 86 year old woman, whose 2 tramadol per day are not helping anymore: Buprenorphine 5mcg/hr patch - Drug not on formulary - Plan does not cover the medication - We cannot do PA. She provided the preferred alternative: Morphine Sulfate ER tablets and Oxymorphone HCL ER tablets, and she submitted a test claim for both medications, stating that it was paid and that no PA was required.
In the midst of the "opioid epidemic" that everyone is...
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Source: Student Doctor Network - November 16, 2023 Category: Universities & Medical Training Authors: drrosenrosen Tags: Pain Medicine Source Type: forums
RFA frequency
Straight Medicare insurance. I did a medial branch RFA for a patient one year ago at THREE levels (billing told me I could) that worked well, >50% pain relief for over a year. Later came to find out that we did not get reimbursed for the third level.
Fast forward a year, I repeat the RFA but only at two levels given our prior denial. Patient reports unsatisfactory pain relief. I looked over the previous and current fluoro images and the needle placement is nearly identical.
My question is...
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Source: Student Doctor Network - November 15, 2023 Category: Universities & Medical Training Authors: Greenbayslacker Tags: Pain Medicine Source Type: forums
CMS Final Rule 2024
Calendar Year (CY) 2024 Medicare Physician Fee Schedule Final Rule | CMS
On November 2, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that announces finalized policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2024.The calendar year (CY) 2024...
www.cms.gov
Looks like psychotherapy did well, but CMS gave a big F*ck You to seniors and others who need neuropsych testing by lowering the RVU conversion factor by 3.4% and leavi...
Source: Student Doctor Network - November 4, 2023 Category: Universities & Medical Training Authors: WisNeuro Tags: Psychology [Psy.D. / Ph.D.] Source Type: forums
The end of community oncology practice
Oncology is about caring for some of the most vulnerable patients in our society but new medicare proposals are just irresponsible
Currently, many oncology practices are forced to close their doors because of ASP (Average Sales price) + 6%, a rule passed in 2003 that medicare will only pay a 6% margin on oncology drugs. Many smaller practices are actually spending more on buying the drugs than what they get in return, forcing them to close their doors.
Now, medicare wants to bankrupt...
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Source: Student Doctor Network - November 2, 2023 Category: Universities & Medical Training Authors: lilPhysician Tags: Hematology / Oncology Source Type: forums
Best place to practice interventional pain
I'm still in residency but very concerned about the future of our great nation. It seems that my most productive years will be spent working hard (something I want to do) and paying high taxes to fund medicare/social security/pensions (several things I DON'T want to do) and on top of it being paid very little to do so...
To top it all off the dollar is dying and the country is propped up on debt and I don't have a good feeling about the economic future.
Does anyone have any leads...
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Source: Student Doctor Network - November 2, 2023 Category: Universities & Medical Training Authors: deleted185747 Tags: Pain Medicine Source Type: forums
Medicare si joint requirements
This probably applies to some commercial as well, as i have gotten information from aetna and certain BCBS out of state plans
For medicare part a & b, do we need to do 2 diagnostic blocks (aka without any steroid usage)? before we can do a therapeutic injection? Or can we actually use steroid in the diagnostic block (the LCD isn't clear)
Thoughts?
whats everyone doing so far?
i can't get a clear answer from my hospital...
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Source: Student Doctor Network - October 11, 2023 Category: Universities & Medical Training Authors: buddababa Tags: Pain Medicine Source Type: forums
Trainee Reimbursement Legislation
Fopr all of you who want interns/postdocs to get paid more, you better be contacting your Senators/Reps about this.
Multipronged advocacy effort leads to introduction of legislation to support Medicare reimbursement for interns and postdoctoral residents
APA applauds Senators Barrasso (R-Wyoming) and Bennet (D-Colorado) for their introduction of the Accelerating the Development of Advanced Psychology Trainees (ADAPT) Act.
www.apaservices.org (Source: Student Doctor Network)
Source: Student Doctor Network - September 23, 2023 Category: Universities & Medical Training Authors: WisNeuro Tags: Psychology [Psy.D. / Ph.D.] Source Type: forums
Tell Medicare Not to Limit Intracept
New criteria would require psych eval and create other hurdles for those suffering from Modic changes. (Source: Student Doctor Network)
Source: Student Doctor Network - September 9, 2023 Category: Universities & Medical Training Authors: drusso Tags: Pain Medicine Source Type: forums
Legitimate or hysterical hit piece? “Doctors Ghost Patients, Charge for Surgeries Left to Residents”
Surgeons Are Double and Triple Booking Procedures That Residents Must Perform
Doctors at some of the largest US teaching hospitals are blowing the whistle on a lucrative practice they say endangers patients: Surgeons scheduling two or even three operations at virtually the same time, leaving during critical portions, then billing Medicare for work they didn’t do.
www.bloomberg.com
Doctors at some of the largest US teaching hospitals are blowing the whistle on a lucrative practice they say endangers patients: Surgeons scheduling two or even three ...
Source: Student Doctor Network - September 2, 2023 Category: Universities & Medical Training Authors: wamcp Tags: Surgery and Surgical Subspecialties Source Type: forums
This could get interesting …. (Legislation to make Anesthesiologists eligible for “Rural Pass-Through” money)
https://www.asahq.org/about-asa/newsroom/news-releases/2023/08/asa-applauds-introduction-of-medicare-access-to-rural-anesthesiology-act
It’ll be interesting to see if this passes, if the AANA fights it, and what opportunities it opens up. As many of you know, the way the law currently stands, it essentially “incentivizes” rural hospitals to use CRNA’s rather than Docs. Thoughts?? (Source: Student Doctor Network)
Source: Student Doctor Network - September 2, 2023 Category: Universities & Medical Training Authors: DirtDocMD Tags: Anesthesiology Source Type: forums
Cut RO payments every year? SURE! Cut drug payments? HOLD ON PARTNER!!!
I'm surprised that this hasn't been discussed yet.
Merck sues US govt to prevent price negotiation
The money quote:
"Merck & Co (MRK.N) sued the U.S. government on Tuesday, seeking to halt the Medicare drug price negotiation program contained in the Inflation Reduction Act (IRA), which it argues violates the Fifth and First Amendments to the U.S. Constitution."
Just like the Founding Fathers intended - pharma companies who manufacture PD-L1 inhibitors should be able to charge...
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Source: Student Doctor Network - August 29, 2023 Category: Universities & Medical Training Authors: Gfunk6 Tags: Radiation Oncology Source Type: forums
