On July 6, 2012, CMS released its 2013 proposed Hospital Outpatient Prospective System (HOPPS) rule at http://www.gpo.gov/fdsys/pkg/FR-2012-07-30/pdf/2012-16813.pdf. This proposed rule will be published in the Federal Register on July 30, 2012.  Comments on this proposed rule will be accepted until…

On Friday, July 6, 2012, the Centers for Medicare and Medicaid Services (CMS) issued its proposed rule to update the Physician Fee Schedule (PFS), effective January 1, 2013. This proposed rule can be found at http://www.gpo.gov/fdsys/pkg/FR-2012-07-30/pdf/2012-16814.pdf or in the Federal…

Over the past two years, we have watched leading payers significantly revise their spine medical policies. Taking it one step further, United Healthcare has just instituted a new Pre-certification form that must be completed by the surgeon’ s office. To…

The attached editorial from the Wall Street Journal on May 29, 2012 is worth reading. A 2.3% levy on medical device gross sales (not profits) is supposed to raise $28.5 billion between 2013-2022. Two initiatives currently underway will hopefully derail…

This draft medical policy is worth skimming. It provides insight as to where BCBS stands on spinal fusion. When finalized, this will be the boilerplate for other BCBS-Plans to roll-out. Please pass this on to others. Any healthcare provider practicing…

Released on CMS website on April 24, 2012: It will be published in the Federal Register on May 11, 2012. [FR Doc. 2012-9985 Filed 04/24/2012 at 4:15 pm; Publication Date: 05/11/2012] This is a PROPOSED RULE: Comments may be submitted…

All too often, a medical device company fails to proactively consider the payer’s perspective before it’s too late. On a daily basis, healthcare customers ask their sales reps… “What codes should we use?“ “Is your product covered by payers?“ “How…