SCOA Delegation Visits Washington, D.C.

The SCOA delegation made the rounds in Washington, D.C., earlier this month as part of the combined AAOS NOLC and Fall Meeting to champion the interests of musculoskeletal patients and orthopaedic surgeons in our state. Our delegation included Doctors Todd Tupis, Chris Mazoue, Shane Woolf and Wendell Holmes as SCOA leaders; Dr. Mike Horan representing Southern Orthopaedic Society; and Dr. Rachel Glenn as Resident delegate.

Representative Wilson personally hosted us in his office and insisted on a picture with the entire group before his staff whisked him away. Representatives Duncan and Norman quickly engaged with us as they were headed to other meetings. Representative Fry lingered with us in the hallway until his staff came looking for him. The SCOA delegation also met with staff members in the offices of Senators Graham and Scott and Representatives Timmons and Mace.

The SCOA delegation joined AAOS members from all states in advocating four issues: Prior Authorization Reform for Medicare Advantage Plans to include a Gold Card Exemption ; Physician Payment Reform linking Payment Adjustments to the Medicare Economic Index; Safety from Workplace Violence in Healthcare Settings and Removing the Ban on Physician Owned Hospitals. Particularly encouraging was Representative Wilson endorsing H.R.2584 (SAVE Act), H.R.977 (Patient Access to Higher Quality Health Care Act of 2023), and H.R.4968 (GOLD CARD Act of 2023) as a co-sponsor immediately following our visit.

CMS Has Recently Published Updated Guidance on the Following Topics:

Limitation on Recoupment of Medicare Overpayments

Click here to download a fact sheet.

Introducing PECOS 2.0

Click here to access educational videos and resources.

Medicare as Secondary Payer: Don’t Withhold Services & Bill Correctly

Click here to download a fact sheet.

2 Big Insurers Take Small Steps to Ease Prior Authorization Burden

Content via the American Medical Association (AMA):

The country’s No. 1 health insurer, UnitedHealthcare (UHC), and another insurance giant—Cigna Healthcare—recently announced tentative steps to reduce the volume of care-delaying, time-wasting prior authorizations they require. Click here to learn more.

Office of Inspector General: Managed Care Strategic Plan

The growth of managed care over the last several years has changed fundamental aspects of the Medicare and Medicaid programs. This significant shift transformed how the government pays for and covers health care for approximately 100 million enrollees.

The OIG has designated oversight of managed care as a priority area. OIG has developed a strategy to align its audits, evaluations, investigations, and enforcement of managed care. The HHS-OIG Strategic Plan for Oversight of Managed Care for Medicare and Medicaid has three goals:

1. Promote access to care for people enrolled in managed care
2. Provide comprehensive financial oversight
3. Promote data accuracy and encourage data-driven decision

Click here to learn more and download the Managed Care Strategic Plan.

Physicians Win Again in ‘No Surprises Act’ Ruling

By Jarrod Fowler, MHA, FMA Director of Healthcare Policy and Innovation

As a result of a lawsuit filed by the Texas Medical Association (TMA), several components of the Centers for Medicare & Medicaid Services (CMS) rule concerning the “No Surprises Act” have been invalidated. This is the fourth lawsuit filed by the TMA, and the ruling is substantially beneficial to physicians. Several of its provisions are noteworthy.

For instance, the judge ruled that “ghost rates” cannot be used in calculations for determining the median in-network rate for physician services, as this is in conflict with the law. That is, the median in-network rate cannot include services that are technically contracted for but which the physician has no intention of providing. Click here to continue reading.

Marketing, Telemarketing, Compliance & Healthcare

Written by: Nancie Lee Cummins, CFE, CHA, CIFHA, OHCC, CHCM, CHCO, CORCM; American Institute of Healthcare Compliance

When a healthcare practice starts talking about, “What can we do to increase business?”, telemarketing always seems to come up. Typically, the health care provider does not have internal resources for this type of project and will hire a professional telemarketing firm. Great idea, right? But, is the telemarketing company operating compliant to federal rules and regulations? Let’s take a closer look at potential compliance risks. Click here to continue reading.

Registration Open: 2024 Annual Meeting

2024 SCOA Annual Meeting

August 1-3, 2024

The Sanctuary

Kiawah Island, SC​

Join us next year along the pristine shores of Kiawah Island for the 2024 SCOA Annual Meeting. Reconnect with your peers as we seek clinical and professional excellence through dynamic keynotes, member talks and research presentations.

Keynote speakers for the 2023 Annual Meeting include Steven L. Frick, MD, and Milt Lowder, PhD.

Register early and secure your 2024 stay with our group rate! Meeting registration is required to receive the booking ID, which will be required to book in our group block.