NYS SOciety of ORTHOPAEDIC Surgeons

A study published in the Feb. 15 issue of the Journal of the AAOS evaluated how Affordable Care Act (ACA)-associated Medicaid expansion impacted the utilization of elective orthopaedic surgery in New York state. The abstract is below.  Full article can be found here.

Background: 

As part of the Patient Protection and Affordable Care Act, states were given the option of expanding Medicaid coverage to include adults younger than age 65 years with income at or below 138% of the federal poverty level. Although this expansion was intended to provide health care coverage to an estimated 20 million Americans, several studies have shown increased coverage does not equate to increased access to care by specialty providers.

Methods: 

We queried the New York Statewide Planning and Research Cooperative System database and identified all patients who underwent the 10 most common elective orthopaedic surgeries from January 1, 2012, through March 31, 2016. Medicaid monthly enrollment for the 4-year study period was obtained from NY Department of Health Medicaid Managed Care Enrollment Reports.

Results: 

Our query identified 700,159 patients who underwent the investigated orthopaedic surgeries. Of these, 60,786 were Medicaid recipients. During the 4-year study period, Medicaid enrollment and the number of procedures reimbursed by Medicaid increased significantly (P < 0.001 for both).

Conclusions: 

Affordable Care Act–supported Medicaid expansion was associated with an increase in Medicaid enrollment and a concomitant increase in the utilization of orthopaedic surgery by Medicaid beneficiaries in New York State.

Late last week, the House Ways & Means Committee issued bipartisan legislation tackling surprise medical billing. The proposal, which is scheduled for markup on Feb. 12, would eliminate balance billing for emergent procedures. Conflicts would be resolved with an independent mediation process.

AAOS is reviewing the proposal and continues to advocate for a fair, accessible Independent Dispute Resolution process for resolving payment disputes.

Contact your congressional representative to voice your concerns.

Each year, KarenZupko & Associates, Inc., (KZA) sends a precourse survey to those who have registered for the KZA/AAOS coding and reimbursement workshops. The results provide insights on a variety of coding, documentation, and revenue-cycle processes and trends. In 2019, KZA received 178 completed surveys.

This article summarizes three revenue cycle data points from the 2019 survey results and provides commentary and guidance from two revenue-cycle experts.

1. Collect at the time of service for office visits and surgery. Most practices could boost their revenue by $25,000 to $75,000 per surgeon by doing this.
2. Adequately document failed conservative treatment in the office note to support that advanced imaging or surgery is indicated. The amount of administrative time spent piecing together information that may or may not exist in the patient’s records is astronomical. A concise summary of the failed conservative treatments, with dates and specifics, significantly reduces the amount of time it takes for preauthorization to be approved.
3. Be proactive with denials. Most denials we see in practices are preventable. Review denial patterns and develop a plan to address them proactively.

—Cheyenne Brinson, CPA (inactive), MBA, of KarenZupko & Associates, Inc. (KZA)

1. Fully preregister patients at the time of scheduling, which includes capturing their full insurance information and verifying eligibility. This essential step lays the groundwork for tips 2 and 3.
2. Collect from patients at the time of service.
3. Collect presurgical deposits.

Tips 2 and 3 are the two most impactful things a practice can do to increase patient collections and decrease patient accounts receivable.

—Amy Anderson, MBA, of KZA

The Academy’s numerous free practice management resources provide knowledge, education, clinical tools, and professional support that help you meet the challenges of your chosen specialty and build mastery throughout your career.

Access white papers, the Practice Management Advice Center, webinar recordings, and learn about topics such as Medicare Access and CHIP Reauthorization Act delivery reform and the Quality Payment Program.

> Practice Management Center

To support the successful implementation of the New York Workers’ Compensation Formulary (NY WC Formulary), the Board continues to educate medical providers and payers about the Formulary and prior authorization process. This includes providing timely responses to frequently asked questions and requests for clarification. This week, the Board published a new round of frequently asked questions (FAQs). Please visit the Board’s Drug Formulary Overview webpage for the latest FAQs as well as:

• An overview of the NY WC Formulary and the prior authorization process
• The latest version of the NY WC Formulary
• A Quick Guide to the NY WC Formulary
• NY WC Formulary Dashboard Guides for Providers and Payers/TPAs

More Information

• For more information, visit the Drug Formulary Overview Page
• General NY WC Formulary questions: WCBFormularyQuestions@wcb.ny.gov
• Technical support questions: WCBCustomerSupport@wcb.ny.gov
• Subscribe for email notifications

The Joint Commission released its updated total hip and knee replacements requirements for hospitals and ambulatory surgical centers that are part of the Advanced Total Hip and Total Knee Replacement Certification program.

Among the new requirements, which take effect on July 1, participating groups are required to follow AAOS clinical practice guidelines.

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On January 17, AAOS submitted feedback to the Centers for Medicare and Medicaid Services (CMS) on its proposal to ease scope of practice restrictions.

The agency had requested input and recommendations on carrying out the President’s recent executive order to eliminate certain supervision and licensure requirements that “limit healthcare professionals from practicing at the top of their professional license.”

In its comments, AAOS stressed the importance of keeping the title "physician" reserved only for those health care professionals who have completed rigorous training and passed the United States Medical Licensing Exam. AAOS also reiterated support for non-physician providers who work as valued members of physician-led care teams. In addition to offering its own comments, AAOS signed onto the American Medical Association’s feedback letter which cited the impact these changes would have on the overall cost and quality of care. Read AAOS’ full comments to CMS…

On the state level, NYSSOS focuses advocacy efforts on ensuring that all patients have access to high quality, comprehensive musculoskeletal care by providers who have met and completed uniform standards for education, licensure, training and certification. > Advocacy Program

• As of December 31, 2019, the minimum wage increases across New York State, and more employees will be eligible to receive overtime pay because the salary threshold for exempt employees also increases. Be sure to update your state and federal labor law posters!
  
  
• Effective January 1, employees taking Paid Family Leave will receive 60% of their average weekly wage and the employees’ contribution increases to 0.270% of gross wages each pay period, up to a max of $196.72 for the year. More information and resources for employers can be found here.
  
  
• On January 6, a statewide ban on salary history inquiries takes effect. The new law prohibits all employers - both public and private - from asking prospective or current employees about their salary history and compensation.
  
  
• By January 7, employee handbooks must include a notice of employees' rights and remedies under a 2019 law that prohibits employment discrimination based on an employee or dependent’s reproductive health decision-making. For more information about the new laws related to workplace discrimination, harassment, and protected classes, click here.

The American Academy of Orthopaedic Surgeons (AAOS), along with JAAOS (aka the “Yellow Journal”), the AAOS Resident Assembly and OrthoMentor have come together to create this forum in order to further the mentorship and education of orthopaedic surgeons during various stages in their career. Authors from the contributing organizations will offer insights into residency transitions, medical school success, attending involvement and more.

Learn More: https://soundsfromthetrainingroom.com/

April 14 - 18, 2020
Holiday Inn Chicago-Mart Plaza
Chicago, Illinois

> Learn More and Register

Faculty draw on material based on common test questions to guide you through the vast amount of content for each specialty area. This focused approach includes dedicated time for high-yield review sessions to re-cap the most important testable facts and concepts.

This blended learning program is the premier course with exclusive pre- and post-event resources with online access to study resources to build your confidence at your own pace. Start preparing early - access to the pre-course content on an exclusive registrant portal will be available in January 2020.