Digirad’s Post

Key Changes in Cardiac Device Evaluation Coding - Important update from the Centers for Medicare and Medicaid Services (CMS). What's New? - Effective January 1, 2024, CMS has eliminated HCPCS Code G2066, previously used for the technical component (TC) in some remote cardiac device evaluations. This is part of the 2024 Medicare Physician Fee Schedule (PFS) revisions. Switch to CPT 93297 & 93298 - In place of G2066, CMS has added technical service (-TC) and professional service (-26) modifiers to both CPT codes 93297 and 93298 for this service. These codes are essential for billing remote interrogations of implantable cardiovascular physiologic monitoring systems (heart failure) and subcutaneous cardiac monitors (insertable cardiac monitors). Why It Matters - This change simplifies coding and billing processes. It is crucial for healthcare providers to adapt to these updates for efficient service delivery and reimbursement. #cieds #remotemonitoring #reimbursement

Twenty-five years ago, as a young academic internist, I came across a piece of technology that changed the trajectory of my life! The first handheld monitor that measures anticoagulation (blood thinner) like diabetics measure blood sugar. With 2 monitors, a nurse and I managed a few hundred patients who no longer had to go to the lab for testing, or play phone tag with their doctors for results. It was a huge success, enhancing clinical outcomes, patient and provider satisfaction, and decreasing cost. I witnessed firsthand the impact of technology on patient care, influencing me to dedicate my career to these types of projects. Over the next 20 years, my journey involved developing a methodology to scale technology solutions within complex healthcare systems despite challenges such as regulation, system complexity, and reimbursement issues. I called it Value-Based Medical Technology Solution (VBMTS) Design. A year ago, I started NewHealthcare Platforms to partner with best-in-class medical technology companies to create value-based solutions that change lives at scale! My first partner is iRhythm which monitoring technology I selected as CMO, Health Plan to expand our ability to diagnose arrhythmia. When I first started doing this work, I had to rely on clinical studies to evaluate technology. I was always uneasy because clinical studies have strictly controlled environments that are different from real world care. Today with advances in EHRs and advanced analytics, massive data sets of healthcare delivery and outcomes, called Real World Evidence (RWE), are available to evaluate medical technology! A recent RWE study of the entire Medicare data set validated that iRhythm's technology stands as best-in-class in diagnosing arrhythmias, a condition that affects millions and leads to severe complications like stroke and heart failure. The study confirmed not just the clinical benefits but also the cost savings associated with using advanced monitoring technologies with iRhythm’s Zio monitor being the most effective, significantly outperformed traditional monitoring methods in diagnosing arrhythmias among Medicare beneficiaries without prior arrhythmia diagnoses. It achieved the highest odds of diagnosis with the lowest odds of retesting, and the lowest healthcare expenditures. I couldn’t be happier with my career choice or more grateful for the opportunity to partner with companies like iRhythm! ___________________________________________ Dr. Sam Basta is a pioneer of Value-Based Care Platforms with two decades experience leading award-winning care delivery transformation at payer and provider organizations. His company, NewHealthcare Platforms, provides consulting services to the Medical Device industry specializing in value-based solution design and go-to-market execution. His thought leadership articles and weekly newsletter are widely followed (25,000+) gaining LinkedIn Top Voice recognition. #healthcareonlinkedin

XiFin supports the passage of the Continuing Appropriations and Extensions Act, 2025, which will provide a one-year reprieve from Medicare payment cuts for approximately 800 critical lab services that were set to take effect in January 2025. While this is a step in the right direction, a permanent fix is crucial to ensure labs can continue delivering essential diagnostic testing. A long-term solution is vital for patient care and lab stability. #Medicare #PAMA #LabServices #Healthcare #DiagnosticTesting

Medicare access to innovative treatments in the works. Medicare recipients are the focus of 4 bipartisan bills recently passed by the House Ways & Means Committee. These bills would provide: ☑ Multi-cancer early detection screening tests ☑ Streamlined process for granting coverage of breakthrough #medicaldevices ☑ Extended coverage for breakthrough devices ☑ Expanded coverage for anti-obesity medication. Currently, Medicare is prohibited from covering medications used for weight loss, like Wegovy. 👉🏼 Read the full article here (https://bit.ly/3SAy07q), which includes links to one-page summaries of each bill. #SABIC #plastics #ChemistryThatMatters #SABICSpecialties #healthcare

Trabecular Bone Score https://lnkd.in/ghdTgpFn CPT code for TBS Trabecular Bone Score is 77089 CPT Code Description $40 - $55 outpatient reimbursed depending on your zip code $80 - $85 in hospital reimbursement Trabecular bone score (TBS), structural condition of the bone microarchitecture; using dual X-ray absorptiometry (DXA) or other imaging data on gray-scale variogram, calculation, with interpretation and report on fracture-risk.

Inpatient GDMT use in a national analysis of HF hospitalizations was lower than reported in quality improvement registries. Discharge GDMT rates were low. Triple/quadruple therapy was administered in 26% of hospitalizations, falling to 14% on discharge. Predischarge GDMT discontinuations were associated with inpatient hypotension, hyperkalemia, and worsening renal function, but 43%-57% had no medical contraindications. In adjusted analyses, use of 3 or more GDMT classes was associated with fewer 90-day all-cause deaths and HF readmissions compared with less comprehensive GDMT. High discontinuation rates emphasize an unmet need for inpatient and postdischarge strategies to optimize GDMT use

An unfortunately disappointing statistic... Reimbursements for radiation therapy under the Medicare Physician Fee Schedule declined by 23% over the past decade. According to this article, the ROCR Act seeks to end this trend and build on the strengths of the previously shelved Radiation Oncology Alternative Payment Model. The new bill aims to maintain the episode-based payment structure while eliminating severe cuts and demanding quality requirements that were part of the former model. I'm curious as to what #radiologists think about this new bill and how it could impact their practices? #Medicare #Healthcare #HealthcarePayments #RegulatoryPractice

It would be encouraging to see UK Healthcare getting more visibility and news coverage, if it didn't feel like a brand new concern every week. Last week the focus turned to Physician Associates. At best, this shows a level of creativity when addressing persistent issues of access and wait times, therefore improving long term health outcomes. At worst, this is another inevitable consequence of the mis-balanced and pressured healthcare system that directly impacts quality of care and patient safety. These medically unqualified roles have been around since ~2005 but have been 'granted' new, often frightening, responsibilities as pressure mounts... and we're still waiting for them to be regulated. With an increased focus on this issue, we are now hearing the risks thick and fast: illegally prescribing prescriptions, involvement in complex surgeries, missing life-threatening diagnoses. One fact that has stuck with me is now less than 50% of NHS GP appointments are with family doctors... the first step for millions of us seeking help. Do we support the 'creativity' here if careful planning is involved? Or see it as yet another signal of a failing #healthcare system? Either one, would we'll be monitoring at #Elixirr and exploring other creative solutions. https://lnkd.in/eftTQDNe

Make sure you understand the nuances of the 2024 Medicare Physician Fee Schedule final rule! The add-on code for complexity, as well as this year's code valuations (Total Disc Arthroplasty, Dorsal SI Fusion, and Vertebral Body Tethering) can be found in the latest issue of SpineLine at https://loom.ly/crCWZT8

CMS sent out their “National Coverage Determination (NCD) Dashboard” 3 lists: ~ NCD Wait List ~ Open NDC’s ~ NCDs Finalized in the Past 12 Months “These are alphabetized lists of NCD requests accepted by CMS, open NCDs, and finalized NCDs. Accepted NCD requests on the Wait List are complete and formal based off CMS’ review consistent with the NCD Request Process. Opened NCDs are topics currently undergoing a National Coverage Analysis (NCA) with opportunities for public comment on the coverage policy. Finalized NCDs have completed the coverage analysis process and represent current Medicare coverage policy.” https://lnkd.in/gZDw3R3W #cms #cmslaw #cmsdevelopment #medicare #ncd #medicareinsurance #medicarepartb #medicareplans #claims #claimsmanagement #revenuecyclemanagement #patientadvocate #patientadvocacy #policy #frm