Clinical Resources Articles
Updates about coding and reimbursement, new practice guidelines, and telemedicine
The Centers for Medicare & Medicaid Services (CMS) will allow Medicare Advantage plans to offer expanded telehealth coverage to beneficiaries, beginning in 2020. This change is due to implementation of the Bipartisan Budget Act of 2018 and is detailed in the Contract Year 2020 [...]
The Centers for Medicare & Medicaid Services (CMS) has made preliminary feedback on all 2018 Merit-based Incentive Payment System (MIPS) data submissions available for review through the Quality Payment Program website. All eligible clinicians who submitted MIPS 2018 data can review preliminary performance feedback [...]
Medicare Administrative Contractors (MACs) are denying coverage for oral appliance therapy for the treatment of obstructive sleep apnea (OSA) in cases in which: A patient has been prescribed positive airway pressure (PAP) therapy as the initial treatment for OSA; The PAP rental [...]
The deadline for submitting 2018 data for the Merit-based Incentive Payment System (MIPS) is March 31. The AASM MIPSwizard provides a platform for you to efficiently submit MIPS data to the Centers for Medicare & Medicaid Services (CMS). In 2018, MIPS performance will be counted [...]
The AASM Payer Policy Review Committee recently reviewed five payer policies, focusing on diagnostic testing for obstructive sleep apnea in adults. The Committee evaluated the insurers’ policies and assigned a score based on nine criteria, aligned with the AASM’s Clinical Practice Guideline for Diagnostic [...]
As one of the updates to the Local Coverage Determination process, the Centers for Medicare & Medicaid Services (CMS) now allows Medicare Administrative Contractors (MACs) the discretion to host multi-jurisdictional Contractor Advisory Committees. Contractor Advisory Committees were established to provide a formal mechanism for [...]
Effective Feb. 20, 2019, the U.S. Food and Drug Administration (FDA) has issued a final order that reclassifies the “auto titration device for oral appliances” as class II (special controls). This type of device is identified as “a prescription home use device that determines [...]
In January the AASM released the Coding and Reimbursement Quick Reference Guide, a new e-book that is available as a free, members-only resource from the AASM online store. This is the latest tool that the AASM offers to help members overcome challenges related to [...]
The AASM Payer Policy Review Committee recently developed new scorecards for five payer policies, focusing on diagnostic testing for obstructive sleep apnea (OSA) in adults. The committee evaluated the insurers’ policies and assigned a score based on nine criteria, aligned with the AASM’s Clinical [...]
The Medicare Administrative Contractor, Palmetto GBA, has published an updated local coverage determination (LCD) policy for polysomnography (L36593), effective for services performed on or after Jan. 1, 2019. Palmetto GBA has revised the ICD-10 Codes that Support Medical Necessity Group 3 by adding the following [...]