What good is Reference-based Pricing when CMS retroactively increases fees on big ticket surgeries?

CMS retroactively updated the Professional Liability Insurance Relative Value Units for several Medicare procedures, which will have a positive impact on spine surgeons, according to an announcement from the International Society for the Advancement of Spine Surgery (ISASS).  

The agency increased RVUs by 0.5 to 1.5 RVUs for select procedures, including:

1. Arthrodesis procedures

2. Total disc replacement

3. Revision total disc replacement

4. Anterior discectomy

5. Laminectomy

6. Vertebral corpectomy

7. Meningocele repair

ISASS listed 41 procedure codes in all that experienced a positive RVU adjustment. CMS updated the payment for claims from July 1 to Dec. 31, 2019, as well as retroactively for claims payed beginning Jan. 1, 2019; providers can connect with local Medicare Administrator Contractors for the retroactive payments.

On the other hand, employers who negotiate contracts are protected from those retro increases if they negotiate that protection in their direct with provider contracts.

What's that? You don't know how to contract direct with providers. Well are you in luck. I am offering a class on that very topic with everything you need to build a surgery cost containment program, and then all the contract templates to contract directly, sans middleman costs, with providers. Click here to learn more about the class on August 27th.

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BTW ISASS, did you look at that set of initials before you branded that name? Yikes!