CMS Responds to Request for Delay of Prior Authorization of Cervical Fusion Procedures In a letter dated June 3, 2021, CMS’ Director of Provider Compliance, Connie Leonard responded to an April 7, 2021, letter from a coalition of healthcare stakeholders, including ISASS, asking CMS to delay implementation of prior authorization in the ambulatory surgical center...

Medicare Administrative Contractors Announce Resumption of Payment Reviews Beginning in August 2020 Beginning August 2020, Medicare Administrative Contractors (MACs) resumed post-payment reviews of items and services with dates of service before March 2020. MACs may now begin conducting post-payment medical reviews for later dates of service. The CMS Targeted Probe and Educate program (intensive...

CMS Post-performance Information From the 2019 Quality Payment Program As of June 2021, the CMS has made available newly added Quality Payment Program (QPP) performance information for physicians, clinicians, groups, and Accountable Care Organizations (ACOs) to the Doctors and Clinicians section of Medicare Care Compare and in the Provider Data Catalog (PDC). CMS is required to report eligible...

Bill Introduced in Congress to Limit Medicare Advantage Prior Authorization On May 21, 2021, House Bill 3173 (117th Congress), which seeks to cut red tape on prior authorizations in Medicare was introduced. The bill would require Medicare Advantage plans to report approval and denial rates. The bill was introduced by Representative Larry Buchon, MD, and...