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Reimbursement

MDMA continues to work with the Centers for Medicare and Medicaid Services (CMS) and Congress to ensure that medical devices are reimbursed at adequate levels. Unfortunately, coverage, coding, and payment processes remain a difficult challenge that manufacturers have to surmount.

MDMA believes that immediate action is needed to ensure that Medicare reimbursement rates accurately reflect hospitals' true cost of performing procedures that utilize innovative medical devices. We have urged CMS to utilize (and hold confidential) third party data submitted by manufacturers, physicians, and hospitals to develop more accurate estimates of device acquisition costs and to use those estimates to develop new rates. We also have worked with Congress to advance legislative proposals that would ease the path to market for new devices, including preservation of a strong local coverage process, more adequate payments for new inpatient and outpatient technologies, and coverage for clinical trials. In meeting with legislators and their staffs or drafting comments to CMS, MDMA seeks to ensure that patients have access to the best and latest innovative products and to ensure that Medicare fosters innovation, rather than stifles it.

In addition to our advocacy efforts, we serve as a reliable source of information for our membership on reimbursement issues. We continue to hold our Annual Reimbursement and Health Policy conferences, which are widely attended. In addition, with regularly scheduled email updates and monthly conference calls specific to Medicare, we provide members with legislative and regulatory updates. We encourage a two-way flow of information, and most of our policy initiatives are concerns that have been brought to us by individual members.

What is MDMA doing?

MDMA assists its members' efforts to improve the health of Medicare beneficiaries by facilitating the introduction of safe and effective medical technologies into clinical practice. By working with the Centers for Medicare and Medicaid Services (CMS) and Congress, we have made significant progress over the past several years - such as achieving positive improvements in coverage for clinical trials, payment for new technologies, and stabilizing reimbursement for critical devices under the hospital outpatient prospective payment system. We also have worked with lawmakers to advance legislative proposals that would ease the path to market for new devices, including preservation of a strong local coverage process.

05/03/2013

The Centers for Medicare & Medicaid Services (CMS) recently issued the Inpatient Prospective Payment Systems (IIPS) proposed rule for fiscal year 2014. The date for implementation of the proposed rule is October 1, 2013, and the window for submitting comments remains open until 5pm ET on June 25, 2013.

The proposed rule calls for a positive payment increase of 0.8% and is generally in line with expectations. Cardiovascular and orthopedic products will receive a 3.7% increase. In...

01/28/2013

 

MDMA submitted comments this week to the Centers for Medicare and Medicaid Services (CMS) regarding their draft guidance for Coverage with Evidence Development (CED). 

While MDMA support CMS’ efforts to improve the CED process to reduce barriers to innovation and improve health outcomes for Medicare beneficiaries, we noted concerns that such efforts do not inadvertently limit patient access to advanced medical technologies.

MDMA reiterated that our members...

11/01/2012

CMS released two final rules impacting medical devices this week. The rules include the CY 2013 Hospital OPPS Final Rule and the CY 2013 Physician Fee Schedule Final Rule. They are both scheduled to take effect on January 1, 2013. 

The OPPS final rule includes changes to the ASC payment system, OQR Program, ASCQR Program, and the IRF...

10/04/2012

Members of the Medicare Payment Advisory Commission (MedPAC) met this week to continue examining reimbursements paid to outpatient hospital departments and stand-alone doctor's offices. 

This past winter, MedPAC recommended that payments for evaluation and management services paid to outpatient departments be lowered so they are equal to payments to doctor's offices. MedPAC is also looking at other ambulatory care services in an effort to "equalize" payments, which could...

04/10/2012

With gathering concerns and pressure from providers that there was not enough time for them to overhaul their billing systems, the Center for Medicare and Medicaid Services (CMS) this week delayed implementation of ICD-10 codes for a year.

CMS originally required providers to start using these codes by Oct. 1, 2013, which entailed increasing the number of codes from approximately 18,000 to 140,000. The proposed rule that was issued this week also makes other changes under HIPAA that...

01/12/2012

 

In one of the first decisions for what is expected to be a uniquely challenging year for reimbursement policies, the Medicare Payment Advisory Commission (MedPAC) recommended that Medicare payments for hospital inpatient and outpatient care in fiscal 2013 be increased by 1 percent.

The commission also voted to recommend that Medicare lower payments to hospital outpatient departments for evaluation and management services so that they are equal to the reimbursements for...

10/20/2011

CMS issued its final rule for accountable care organizations (ACOs) today, and various stakeholders are providing mixed reactions.
 
"While we continue to examine this rule, it appears that these regulations could thwart what the Affordable Care Act was intended to accomplish:  ensuring patients have access to innovative and life saving therapies and technologies," said MDMA President and CEO Mark Leahey.  "There also appears to be perverse incentives for physicians and...

06/21/2011

MDMA submitted comments to the Centers for Medicare and Medicaid Services (CMS) for the FY2012 proposed rule for the Inpatient Prospective Payment System (IPPS). The proposed rule on IPPS affects most reimbursement for items, services, and procedures under the Medicare inpatient system. The proposal calls for an overall negative payment update under the system.

MDMA noted that we continue to have concerns over proposals for new-technology add-on payments.

“Ensuring that new...

02/03/2011

MDMA submitted comments this week to the Centers for Medicare and Medicaid Services (CMS) to address the problems with “payment lag” for new and innovative medical technologies.

MDMA highlighted that adequate payment through a consistent and fair application of new-technology add-on rules is essential to continued improvements in patient care.

To read the full comments, click on the link below.

12/16/2010

MDMA today submitted comments to Dr. Donald Berwick, Administrator of the Centers for Medicare and Medicaid Services (CMS), and Dr. Margaret Hamburg, Commissioner of the Food and Drug Administration (FDA), regarding the “parallel review” proposal for medical devices.  The intent of a parallel review is to reduce the time between FDA market approval and the CMS national coverage determinations (NCDs).

Mark Leahey, President and CEO of MDMA, noted that while the intent of the...