CMS Will Require Data On Your Global Periods In 2017
CMS was on the verge of eliminating all global periods associated with surgical procedures in 2016, thanks to a provision in the 2015 Medicare Physician Fee Schedule, but was stopped at the last minute by a provision in the Medicare Access and CHIP Reauthorization Act (MACRA), the same law that birthed the new Merit-based Incentive Payment System (MIPS).
These legislative maneuvers resulted in a compromise from the federal government. MACRA effectively paused the move to eliminate global surgical packages and replaces it with a requirement that CMS must first collect data to properly value surgical services. This article will take a closer look at this data-gathering requirement, which first appeared in the 2017 Medicare Physician Fee Schedule proposed rule, released in July.
Remember: Any of the details described below may change in the final rule, expected sometime in late October or early November.
Under the proposed rule, CMS will begin to require detailed data on all surgical procedures with 10-day or 90-day global periods on Jan. 1, 2017. This is actually the first of a three-part approach outlined in the proposed rule. The three components include:
- Claims-based reporting that captures the frequency and E/M level of pre-operative and post-operative visits. All providers will be expected to participate in claims-based reporting, which requires practices to report several new, no-pay informational codes on each claim. No penalty is currently proposed against non-participating providers, but CMS has said it reserves the right to add a penalty if the response rate is too low.
- Representative survey sample of providers about the types of services provided and resources used in pre-operative and post-operative visits. CMS will randomly select a representative sample of approximately 5,000 providers across multiple specialties. Each provider will be asked to provide detailed data on 20 unique patient encounters.
- In-depth site visits at a small number of sites, including Accountable Care Organizations (ACOs). These are opportunities for CMS officials to engage in “direct observation” at a small number of sites, both to help design the survey (mentioned in #2 above) and to validate the survey results.
CMS is partnering heavily with the Arlington, Va.-based RAND Corporation to accomplish all of these objectives. RAND designed the reporting codes for the first component and will also help design the survey for the second component, working in conjunction with NORC, an independent research organization based at the University of Chicago.
Claims-based reporting (all providers)
CMS lists 10 new G-codes in the proposed rule that were developed by the RAND Corporation to capture most of the data it believes is necessary to reprice surgical procedures and eliminate global periods.
The codes are (the “XXX” are placeholder digits that will be replaced with actual numerals in the final rule):
- GXXzX1. Inpatient visit, typical, per 10 minutes, included in surgical package
- GXXX2. Inpatient visit, complex, per 10 minutes, included in surgical package
- GXXX3. Inpatient visit, critical illness, per 10 minutes, included in surgical package
- GXXX4. Office or other outpatient visit, clinical staff, per 10 minutes, included in surgical package.
- GXXX5 Office or other outpatient visit, typical, per 10 minutes, included in surgical package.
- GXXX6 Office or other outpatient visit, complex, per 10 minutes, included in surgical package.
- GXXX7 Patient interactions via electronic means by physician/NPP, per 10 minutes, included in surgical package.
- GXXX8 Patient interactions via electronic means by clinical staff, per 10 minutes, included in surgical package.
RAND published a detailed white paper on how it developed these G-codes, which states that it did interview physicians and non-physician practitioners from more than 30 specialties practicing across 22 different states.
The survey will reach 5,000 providers, which is a fairly small number. CMS believes this component is needed to supplement the mass claims-based data described above. Claims-based reporting may not accurately capture payment rates for pre-op and post-op services, while the more detailed survey instrument will capture provider activities, time spent, and resources involved in pre-op and post-op services.
This particular aspect of the proposal contains a considerable number of gray areas as outlined in the proposed rule. Specifically, CMS hasn’t decided how it will choose its sample, but it will be of providers who furnish at least 200 procedures with a 10-day or 90-day global period.
The lucky few that are chosen will be asked for details such as:
- Procedure codes and date of service for the procedure that initiated the global period
- Place of service
- Sequence of follow-up visits
- E/M code levels for visits
- Specific activities during each visit, include pre-service, face-to-face, and post-service activities
- Times spent for each activity
- Which provider, physician or other practitioner, performed which aspect of each service
- Practice expense components, such as surgical dressings or clinical staff time
In-depth site visits
This final component will be the most limited in scope, affecting providers in 4-6 ACOs, CMS states in the proposed rule. These on-site visits will allow CMS to collect information that can’t easily be captured by survey-based reporting, including whether ACO providers must spend more or less time and effort on post-op services during their global periods.
Details are sketchy on this component, but the odds are your practice won’t be chosen unless it is an active ACO participant, and even then the odds are very low.
The comment period for the 2017 fee schedule rule ended on Sept. 6, though you can view the catalogue of submitted comments here on Regulations.gov. CMS usually releases the fee schedule final rule at the end of October or during the first week of November.
— Grant Huang, CPC, CPMA (email@example.com). The author is Director of Content at DoctorsManagement.