News & Information

Back in August of 2018, as part of the Medicare Shared Savings Program (Shared Savings Program), CMS proposed some sweeping changes for Accountable Care Organizations (ACOs). There has been some controversy over these changes which require ACOs to move to two-sided models. In this Final Rule which was scheduled to be published in the Federal Register on December 31, 2018, they address the comments and concerns submitted during the comment period.

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Center for Medicare and Medicaid Innovation (CMMI) models are created by CMS to test innovative payment techniques and service delivery models. As of November 2018, here are some CMMI models:

  • Medicare Diabetes Prevention Program
  • ACO Models (e.g., Pioneer ACO, Next Generation ACOs)
  • Independence at Home Model
  • Comprehensive Primary Care Plus
  • Oncology Care Model
  • Joint Replacement Model

See the References to be linked to Medicare's page listing all Innovation Models.

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Question:

We have been receiving several DDS referrals to our massage therapists who do intra-oral work. The only problem is that the referral from the DDS lists code R51 for headaches as the only DX code. Since most plans don't cover massage therapy for headaches alone, are there any codes that can distinguish the headaches as TMJ related so they can be more widely covered?

Answer

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In January, the U.S. Department of Health and Human Services (HHS) issued updates to the privacy regulations regarding the confidentiality of patient information of substance use disorder patients (42 CFR Part 2).  This notice included references to better alignment with HIPAA regulations, but did state that Part 2 is more protective in order to retain "important privacy protections for individuals seeking treatment for substance use disorders." 

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The list of settings where a physician’s services are paid at the facility rate include:
  • Telehealth (POS 02);
  • Outpatient Hospital-Off campus (POS code 19);
  • Inpatient Hospital (POS code 21);
  • Outpatient Hospital-On campus (POS code 22);
  • Emergency Room-Hospital (POS code 23);

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