Summaries of Regulations and their Impact on Otolaryngology—Head and Neck Surgery

Summaries of Regulations and their Impact on Otolaryngology—Head and Neck Surgery

*NEW* Academy Summarizes Impact of CMS 2015 MPFS Final Rule (11/26/2014)

The Academy has summarized payment  rules and policies from the 2015 final Medicare Physician Fee Schedule (MPFS) that are specific to the Otolaryngology community. Issues include: transitioning all 10- and 90-day global codes to 0-day global codes,  identifying approximately 65 codes as “potentially misvalued” and requiring review, and conducting the statutorily mandated five year update to malpractice RVUs. To view the summary, click the link below:

Academy Summarizes Impact of CMS 2015 Proposed Policies on the Otolaryngology Community (7/31/2014)

The Academy has summarized payment  rules and policies from the 2015 proposed Medicare Physician Fee Schedule (MPFS) that are specific to the Otolaryngology community. Issues include: transitioning all 10- and 90-day global codes to 0-day global codes,  identifying approximately 65 codes as “potentially misvalued” and requiring review, and conducting the statutorily mandated five year update to malpractice RVUs. This is one of many federal policies that the Academy comments on to advocate for appropriate national policies on your behalf.  To view the summary, click the link below:

Academy Releases Summary of CY 2014 Final Payment Policies for Hospital Outpatient and Ambulatory Surgical Centers 

The Academy has summarized  key provisions affecting Otolaryngology such as: 2014 proposed payment rates, policies affecting hospital outpatient visits, supervision requirements for therapy services, new payment packaging proposals, and quality program requirements.  The Academy has summarized the OPPS and the ASC sections of the rule separately below:

Academy Releases Summary of the 2014 Final Medicare Physician Fee Schedule (MPFS)
The Academy has summarized the key provisions affecting Otolaryngology in the Centers for Medicare & Medicaid Services (CMS) MPFS final rule CY 2014, including:  changes to the payment policies for 2014, Value Based Payment modifier Program, the Physician Quality Reporting System Program (PQRS), and more. 

CMS Issues 2014 Final Rules for the Medicare Physician Fee Schedule and Hospital Outaptient  / Ambulatory Surgical Centers (12/6/2013)
On November 26 CMS released the final 2014 Medicare Physician Fee Schedule (MPFS) and Hospital Outpatient Prospective Payment System (HOPPS)/Ambulatory Surgical Centers (ASCs) rules. Key provisions within the MPFS include acceptance of 4 sinusitis measures for 2014 PQRS reporting and CMS’ retraction of their proposal to cap services paid more in the office at the outpatient or ASC rate. The Academy is reviewing both rules and will provide detailed summaries in the coming weeks. Links to both final rules are provided below.

Academy Releases Summary of CY 2014 Proposed Payment Policies for Hospital Outpatient and Ambulatory Surgical Centers
On July 8th, the Centers for Medicare & Medicaid Services (CMS) released the proposed rule for the 2014 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Centers (ASCs). The proposed rule contains several key provisions, including: 2014 proposed payment rates, policies affecting hospital outpatient visits, supervision requirements for therapy services, new payment packaging proposals, and quality program requirements.  The Academy has summarized the OPPS and the ASC sections of the rule separately below: 

Academy Releases Summary of Key Provisions for the 2014 Proposed Rule for the Medicare Physician Fee Schedule
The Centers for Medicare and Medicaid Services (CMS) released the proposed rule for the 2014 Medicare Physician Fee Schedule. The Academy has reviewed and summarized several payment and policy issues affecting the otolaryngology committee including the Physician Quality Reporting System (PQRS), including the acceptance of four adult sinusitis clinical quality measures, the development of a value based purchasing payment modifier, 2014 payment rates and more. Read the summary below.

Academy Summary of 2014 proposed MPFS (7/25/13)

Academy Releases Summaries of Key Provisions for the 2013 Final Rules for the Medicare Physician Fee Schedule and Hospital Outpatient / Ambulatory Surgical Centers.
The Centers for Medicare and Medicaid Services (CMS) released the final 2013 Medicare Physician Fee Schedule (MPFS) and the finalized payment rates for Hospital Outpatient Prospective Payment System (HOPPS) and Ambulatory Surgical Centers (ASCs). The Academy has reviewed the MPFS final rule and has released a detailed summary outlining many of the key provisions contained in the rules that affect Otolaryngologists- Head and Neck Surgeons. The Academy has additionally reviewed the OPPS and ASC final rule and has released a summary outlining key provisions below.

Academy Summary of 2013 finalized Medicare Physician Fee Schedule (11/15/12)
Academy Summary of 2013 finalized HOPPS and ASC Payment (11/29/12)


Academy Releases Summary of Key Provisions for the 2013 Proposed Rules for the Medicare Physician Fee Schedule and Hospital Outpatient/ Ambulatory Surgical Centers
CMS released the proposed 2013 MPFS and the proposed payment rates for HOPPS and ASCs.

The Academy reviewed the MPFS proposed rule and the proposed HOPPS/ASC rule and have released a detailed summary outlining many of the key provisions containted in the rules that affect Otolaryngologist- Head and Neck Surgeons.

Academy Summary of 2013 proposed Medicare Physician Fee Schedule
Academy Summary of 2013 proposed HOPPS and ASC Payment

Click below to see the proposed MPFS rule and proposed HOPPS and ASC payment rate rule:

2013 proposed Medicare Physician Fee Schedule (MPFS)
2013 proposed payment rate for Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center (HOPPS and ASC)

CMS Releases Final Rule Outlining Changes in Provider Enrollment Requirements for Ordering Referring Physicians
On April 27th, the Centers for Medicare and Medicaid Services (CMS) issued a final rule outlining changes in provider enrollment for ordering and referring physicians in Medicare. The rule clarifies that these requirements will only apply to those who order or certify: durable medical equipment, prosthetics, orthotics, and supplies (DEMPOS); clinical laboratory services; imaging; and home health services.

CMS Issues Proposed Rules to Address Unneccesary, Obsolete, or Excessively Burdensome Medicare and Medicaid Regulations To see a summary of provisions affecting Otolaryngology- Head and Neck Surgery, click here.