The Office of Inspector General found CMS overpaid $636 million for neurostimulator implantation surgeries between 2016 and 2017, according to an audit of outpatient hospital and ASC claims.
The audit covered $1.4 billion in Medicare payments for 61,125 neurostimulator implantation surgery claims, the OIG said Oct. 1.
The office found that more than 40 percent of the healthcare providers did not comply with CMS requirements when they billed for neurostimulator implantation surgeries, totaling $636 million in overpayments.
The office recommends healthcare providers mitigate these errors by running a report on the CPT codes (61885, 61886 and 63685) and identifying the frequency, provider, dates of service and total charges of the procedures.
The OIG also identified action items for CMS, including identifying and recovering potential overpayments.
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Final Policy for Epidural Steroid Injections for Pain Management Released
CGS has released its final policy for epidural steroid injections for pain management has been released. This will be effective 12/5/2021. Please check your individual MACs.
There are some changes as per the request of ASIPP and other societies in reference to the definition of inclusion criteria:
· This now includes radicular pain, severe degenerative disc disease, and post laminectomy syndrome.
· An objective pain scale or functional assessment must be performed at baseline and repeated at each follow-up for assessment of response.
· Pain duration of at least four (4) weeks, and the inability to tolerate noninvasive conservative care or medical documentation of failure to respond to four (4) weeks of noninvasive conservative care.
· Only one spinal region may be treated per session.
· No more than 4 epidural injection sessions may be reported in all anatomic regions in a rolling 12-month period regardless of the number of the levels involved.
· Essentially for a person with 2 regions involved, it will result in only 2 procedures per year.
Diagnostic codes do not include disc displacement and disc degeneration. All in all, the policy is extremely difficult to live with, not only for diagnostic coding, but for limitation of procedures limited to 4 per year for all regions combined.
LCDs released are:
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Epidural injections of local anesthetic with or without steroids may effectively manage lumbar radiculopathy, with moderate to strong evidence available, according to a systematic review and meta-analysis of randomized controlled trials results published in Pain Physician.
In the current review, researchers sought to evaluate the efficacy—or lack thereof—of epidural injections with saline, local anesthetic alone, or local anesthetic with steroids, and compare those results with results of a recently published Cochrane Review.
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Number is double that for 2019, but methodology changes may explain much of that, official says
More than 40 million Americans were living with a substance use disorder in 2020, Capt. Michael King, PhD, MSW, of the Substance Abuse and Mental Health Services Administration (SAMHSA) said Monday.
King was reporting on the results of the SAMHSA annual National Survey on Drug Use and Health for 2020. "Many longstanding behavioral health problems are still here and are possibly getting worse," King, who is acting director of SAMHSA's Center for Behavioral Health Statistics and Quality, said on a phone call with reporters. And although the 40 million figure represents a doubling from 2019's estimate of 20 million, King cautioned that "the difference is most likely due to one of the changes in how we conduct our survey and it was a planned change, long in coming -- a change in the diagnostic criteria manual from the DSM-4 to DSM-5. In addition, many of our other methodological changes impacted this number more than likely, so while the number appears much larger, there are many caveats to that."
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There is about $26.8 billion of unused money in the COVID-19 Provider Relief Fund and more could be on the way as providers return grants, according to an analysis from The Urban Institute, a nonprofit economic and social policy research organization.
For the analysis, published Oct. 26 and commissioned by the Robert Wood Johnson Foundation, the Urban Institute used the most recent publicly available information to review how the $178 billion relief fund was allocated into general and targeted distributions and paid to providers.
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Oakland, Calif.-based Kaiser Permanente and various affiliates defrauded Medicare of about $1 billion by adding diagnoses to patients' medical records to increase reimbursement, the Justice Department alleged in a complaint filed Oct. 25.
The Justice Department alleges that Kaiser physicians submitted inaccurate diagnosis codes for Medicare Advantage beneficiaries from 2009 through 2018, according to Law360. Kaiser allegedly pressured physicians to create addenda to medical records after patient visits to add diagnoses that patients did not have or were not addressed during the in-person visit, according to Bloomberg Law.
"The driver was money: so that Kaiser could submit these improper diagnoses to CMS for payment," the Justice Department's complaint reads.
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ASIPP® is pleased to offer a new feature for
its members to help provide value to you and your practice.
Click here to visit ASIPP®'s newly created site where you can
make purchases on our Amazon Store, learn more about and
join the ASIPP® GPO and ASIPP®’s partnership with
Fedora Billing & Revenue Cycle Management Company.
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The extra doses are expected to become available in coming days, once the CDC offers guidance on usage
U.S. health regulators significantly widened the nation’s COVID-19 booster campaign, clearing use of extra doses of Moderna Inc. and Johnson & Johnson vaccines and also saying people can get a shot that is different from what they had previously received.
The moves, announced by the Food and Drug Administration on Wednesday, will make boosters available to the majority of adults who have been fully vaccinated and have passed the recommended waiting period.
Now every COVID-19 vaccine authorized in the U.S. also has a booster. And people who took one company’s shot to get vaccinated could choose to get a booster dose made by a different company.
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General Hospital has suspended nonemergency surgeries because of staff shortages, The Bradford Era reported Oct. 26.
Surgeries of "urgent and emergent cases" will still be performed.
New York Gov. Kathy Hochul said in September that she would consider asking the National Guard for help during staffing shortages.
The hospital had been offering higher compensation and signing bonuses to attract more staff, and had been using staffing agencies, the article said.
An appeal for help is expected today, October 27.
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Emergency call centers don't have what they need to handle mental health and substance use crises, according to a survey by the Pew Charitable Trusts.
"When it comes to responding to behavioral health crisis calls, 911 call centers are really the lynchpin to the success," said Tracy Velázquez, Pew's lead researcher on the report. "Our report suggests some missing resources to respond appropriately."
About two-thirds of responding centers (25 out of 37) said call-takers and dispatchers at their call center didn't have any specialized behavioral health crisis training, citing staff turnover and budget issues as barriers. Notably, call centers in areas with predominantly white populations were more likely to have training.
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Pain Medicine Case Reports (PMCR) and Editor-in-Chief Alaa Abd-Elsayed, MD, PhD would like to invite you to submit case reports and case series to the PMCR journal. Your article will be published free of charge.
Open access journals are freely available online for immediate worldwide open access to the full text of published articles. There is no subscription fee for open access journals. Open access journals are no different from traditional subscription-based journals: they undergo the same peer-review and quality control as any other scholarly journal.
Interested in becoming a member of the PMCR Editorial Board?
Editorial board members are asked to review 2-6 manuscripts per year. Please submit your most up-to-date CV to sgold@asipp.org for consideration.
For more information or to submit your articles, click here.
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| CASE REPORT |
Erik Shaw, DO
Abstract
Background: Intercostal neuralgia is a debilitating condition that commonly occurs following thoracic surgeries. Presented here are 2 cases that highlight the potential of percutaneous peripheral nerve stimulation (PNS) targeting the intercostal nerves to provide immediate and sustained pain relief without permanent implantation.
Case Report: Two patients with chronic postthoracotomy intercostal neuralgia received up to 60 days of PNS with implanted percutaneous leads. Both patients reported 80%-90% reductions in pain intensity by the end of the 60-day PNS treatment. At last follow-up, 13-14 months after lead removal, both patients continued to report substantial levels of pain relief as well as cessation or significant reduction of opioid and non-opioid pain medications.
Conclusion: These cases suggest that 60-day percutaneous PNS may be applied to effectively treat nerve pain in the distribution of the intercostal nerves during the 60-day treatment and also may enable long-term sustained relief following the end of the PNS treatment period.
Key words: Intercostal neuralgia, post-thoracotomy pain, chronic pain, peripheral nerve stimulation, neuromodulation, case report
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| SYSTEMATIC REVIEW |
Lu Lin, MD, Si Cheng, MD, Yang Wang, MD, Xiaolin Chen, MD, Guosheng Zhao, MD, Zhiqiang Wang, MD, Xiaojiong Jia, PhD, and Zhenyong Ke, MD
Abstract
Background: Intrawound treatments have been reported to have favorable efficacy for preventing surgical site infection (SSI); however, the best strategy remains unknown.
Objective: The aim of this systematic review and network meta-analysis was to evaluate the efficacy of intrawound treatments to prevent SSI after spine surgery.
Study design: A systematic review and network meta-analysis.
Methods: We searched the Cochrane Library, EMbase, PubMed, Chinese Science and Technology Periodical Database (VIP), China National Knowledge Infrastructure (CNKI), and Wanfang Data from the date of inception to March 2, 2020. The randomized controlled trials (RCTs) and cohort studies were identified and extracted by 2 reviewers independently. We performed a traditional pairwise meta-analysis to evaluate overall efficacy of intrawound treatments. Meanwhile, a network meta-analysis was performed to compare and rank the treatment efficacy using frequentist approach.
Results: Thirty-three publications (6 RCTs and 27 retrospective cohort studies) were included, involving 22,763 patients. For pairwise meta-analysis, the combined results showed that the intrawound treatment had a significantly lower SSI rate than the control group (CG) (odds ratio [OR] = 0.41; 95% confidence interval [CI], 0.31-0.55). For network meta-analysis, the treatment of vancomycin (VA) (OR = 0.53; 95% CI, 0.39-0.71), povidone-iodine (PI) (OR = 0.10; 95% CI, 0.04 - 0.23), and vancomycin + povidone-iodine (VA+PI) (OR = 0.25; 95% CI, 0.11-0.58) were found to be significantly more efficacious than CG on reduction of SSI rate. PI ranked first on reducing SSI, followed by PI+HP, VA+PI, gentamicin (GM), VA, and hydrogen peroxide (HP); CG ranked last.
Limitations: Firstly, only 6 RCTs are included in this systematic review. Retrospective cohort studies tend to exaggerate the real results, although most of them are high-quality according to the Newcastle-Ottawa Quality Assessment Scale (NOQAS). More high-quality RCTs need to be included to obtain convincing conclusions. Secondly, the population of this study involves both adult and pediatric cohorts, patients with tumor, congenital disease, or degenerative disease. There is no subgroup analysis for ages and type of diseases, which might have influence on the overall pooled analysis. Thirdly, we define the application of saline solution and no intrawound treatment as the control group, which might ignore their heterogeneity. Fourthly, follow-up periods are variable and the sample size of HP is small. Finally, additional research is needed to compare the complications of different treatments and the benefits of various dosages.
Conclusion: We found that VA and PI show promising results on reducing SSI. PI is recommended as the most efficacious intrawound treatment to prevent SSI after spine surgery.
Keywords: network meta-analysis; spine; surgery; surgical site infection; Intrawound treatments.
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| RANDOMIZED CONTROLLED TRIAL |
Douglas P. Beall, MD, Timothy Davis, MD, Michael J. DePalma, MD,
Kasra Amirdelfan, MD, Edward S. Yoon, MD, Gregory L. Wilson, DO, Randolph Bishop, MD, William C. Tally, MD, Steven L. Gershon, MD,
Morgan P. Lorio, MD, FACS, Hans Joerg Meisel, MD, PhD,
Meredith Langhorst, MD, Corey W. Hunter, MD, and Timothy Ganey, PhD
Abstract
Background: A viable disc tissue allograft has been developed to supplement tissue loss associated with degenerative lumbar disc disease and the development of chronic discogenic lower back pain.
Objectives: Viable disc allograft was injected into painful degenerated discs to evaluate safety and determine whether it can improve pain and function.
Study Design: Patients received an active treatment of allograft or saline, or continued with nonsurgical management (NSM). Prior to entering the study, patients had back pain for a minimum of 6 months before treatment that was recalcitrant to nonoperative treatment modalities. Standardized outcome measures were used to evaluate the patient’s condition before and after treatment. Primary endpoints included improvement in Oswestry Disability Index (ODI) and Visual Analog Scale of Pain Intensity (VASPI). Conventional radiographs and magnetic resonance imaging scans were used to assess disc space height and spinal alignment, and to determine the degree of disc degeneration. Patients were followed for one year after enrollment. The NSM group could cross over to the allograft group after 3 months.
Setting: This multicenter trial was completed in outpatient surgical centers and office injection suites. A total of 218 patients with chronic low back pain secondary to single-level or 2-level degenerative disc disease were enrolled. Inclusion criteria included pretreatment VASPI >= 40 mm, ODI score >= 40 and symptoms present longer than 6 months. Patients were blinded and randomized to receive intradiscal injections of either viable disc allograft or saline. Patients randomized to the NSM group continued existing treatment. Patients were assessed at 6 and 12 months. Adverse events (AEs) were continually assessed.
Methods: The VAST trial is a prospective, multicenter, blind, randomized clinical trial (RCT) for patients with single-level or 2-level degenerative lumbar disc disease.
Results: At 12 months, clinically meaningful improvements in mean VASPI and ODI scores were achieved in the investigational allograft and saline groups. A responder analysis demonstrated a clinically meaningful reduction in ODI of >= 15 points at 12 months that was statistically significant; 76.5% of patients randomized to allograft were responders (P = 0.03) compared to 56.7% in the saline group. A responder group characterized by a ? 20 point reduction in pain at 12 months achieved a statistically significant reduction in pain compared to the saline group (P = 0.022). In the allograft group, 11 safety adverse events occurred in 141 patients (3.5%) and there were no persistently symptomatic AEs.
Limitations: Limitations of this study include a comparison to saline that has been shown to be more representative of an active comparator as opposed to a placebo. In addition, 36 patients were lost to follow-up; this loss resulted in the saline and NSM/crossover groups being smaller than the predetermined group size to have an appropriately powered analysis.
Conclusions: This large, prospective blinded RCT demonstrated safety and efficacy results indicating that viable disc tissue allograft may be a beneficial nonsurgical treatment for patients who have chronically painful lumbar degenerative discs. Further studies would be optimal to confirm efficacy.
Keywords: Viable disc tissue allograft, discogenic back pain, allograft supplementation, degenerative disc disease, low back pain, intervertebral disc, intradiscal injection
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Since this malpractice insurance program officially launched in November 2018, ASIPP has signed up hundreds of providers with an average savings of 30%. This is professional liability insurance tailored to our specialty and will stand up for us and defend our practices.
Norcal Mutual is 'A' Rated by AM best and is license in all 50 states. To read a few important points to keep in mind about the program, including discounts, administrative defense, cyber coverage, aggressive claims handling, and complimentary award-winning risk management CME activities, click here.
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ASIPP® is now offering our members the benefit of a unique revenue cycle management/ billing service. We have received a tremendous amount of interest in the ASIPP® billing and coding program.
Click here to learn more about the negotiated rate for practices and more!
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ASIPP® has formed a partnership with Henry Schein and PedsPal, a national GPO that has a successful history of negotiating better prices on medical supplies and creating value-added services for the independent physician. Working with MedAssets, PedsPal provides excellent pricing on products like contrast media that alleviate some of the financial pressures you experience today.
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