Health Policy

• Attention Health Professionals:  Information Regarding the Holding of 2012 Date-of-Service Claims for Services Paid Under the 2012 Medicare Physician Fee Schedule
  The negative update under current law for the 2012 Medicare Physician Fee Schedule is scheduled to take effect on Sun Jan 1, 2012, eight business days from today.  Consequently, as on numerous occasions in the past, CMS will instruct its Medicare claims administration contractors to hold claims containing 2012 services paid under the Medicare Physician Fee Schedule for the first 10 business days of January 2012 (i.e., Sun Jan 1 through Tue Jan 17).  The hold should have minimal impact on provider cash flow because, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt.
  Medicare Physician Fee Schedule claims for services rendered on or before Sat Dec 31 are unaffected by the 2012 claims hold and will be processed and paid under normal procedures and time frames.
  The Administration is disappointed that Congress has failed to pass a solution to eliminate the sustainable growth rate (SGR) formula-driven cuts, and has put payments for health care for Medicare beneficiaries at risk.  We continue to urge Congress to take action to ensure these cuts do not take effect.
  CMS will notify you on or before Wed Jan 11, 2012, with more information about the status of Congressional action to avert the negative update and next steps regarding the claims hold.
• CMS Releases MLN Matters Special Edition Article for providers and suppliers regarding a predictive analytics system CMS is using as of June 30, 2011 to analyze all Medicare FFS claims to detect potentially fraudulent activity. The predictive analytics system uses algorithms and models to examine Medicare claims in real time to flag suspicious billing. This article briefly explains the predictive modeling system, its purpose, and how CMS is incorporating the system into its claims payment process.
• Announcing AAHKS Health Policy Fellow 2011 - 2012
• The Proposed Rule (please be advised that this is over 400 pages) 
• CMS summary of the proposed rule  
• CMS beneficiary fact sheet 
• Frequently asked questions about ACOs
• CMS press release about the release of the rule
• CMS provider fact sheet
• CMS quality fact sheet
• Accountable Care Organizations
• Information for Our Patients Regarding Metal-on-Metal (MoM Hip Replacements
• Change in the Medicare Conversion Factor: What this means to you!
• The Implants Loophole
  Excerpt: A recently recalled artificial hip made by a unit of Johnson & Johnson, designed to last 15 years or more, is failing worldwide at unusually high rates after just a few years. One of the most troubled orthopedic implants of the past decade, this artificial hip — known as the A.S.R., or Articular Surface Replacement — was originally promoted as a breakthrough in design that would last longer and provide patients more natural movement. But many patients soon developed inexplicable pain, and surgeons, when replacing the implant, discovered mysterious masses of dead tissue near the thighs of some patients.
• The Unintended Consequences of Government Intervention
• Advocacy Tools
• AAOS Government Relations page
• AAOS Professional Compliance Program
• Hip and Knee Implants: Current Trends and Policy Considerations
• Government Relations
• AMA Advocacy – Take Action!
• AMA/Specialty Society RVS Update Committee
• Alliance of Specialty Medicine
• The Commonwealth Fund
• AARP Health Policy
• American Hospital Association Advocacy
• Association of American Medical Colleges