February 15, 2016

New Technology Equals Additional Reimbursement

By

Today, February 16, the Centers for Medicare & Medicaid Services (CMS) is holding a New Technology Town Hall Meeting at the CMS Headquarters in Baltimore.

The New Technology meeting is being held to allow the agency to review applications for New Technology designation in the Medicare Severity-Diagnosis Related Groups (MS-DRGs) reimbursement methodology for the Inpatient Prospective Payment System (IPPS). This designation is important for hospitals as it means the potential for additional reimbursement. During the 2016 fiscal year, the additional reimbursement ranged from $1,000 to $72,000 per case.

New technology add-on payments were created to ensure that hospitals were adequately compensated for new devices and/or procedures. The criteria for new technology includes requirements that the medical service or technology be new (within 2-3 years), that it demonstrates significant clinical improvement, that it has gained approval by the Federal Drug Administration (FDA), and that it can be identified by CPT, HCPCS, National Drug Code, or ICD-10-PCS (formerly ICD-9-CM Volume 3) codes.

The Town Hall meeting will focus on the 2016 New Technology designations and determine if they should continue. These 2016 technologies included:

  1. Argus II Retinal Prosthesis System: a device used to treat retinitis pigmentosa that had a potential additional reimbursement of $72,028.75.
  2. Cardio-MEMS HF Monitoring System: a device used to treat heart failure that had a potential additional reimbursement of $8,875.
  3. MitraClip: a device used to treat mitral valve regurgitation that had a potential additional reimbursement of $15,000.
  4. Responsive Neurostimulator (RNS) System: a device used to treat epilepsy that had a potential additional reimbursement of $18, 475.
  5. BLINCYTO (Blinatumomab): a substance used to treat acute lymphoblastic leukemia that had potential additional reimbursement of $27.017.15 based on a 17-day treatment cycle.
  6. Lutonix Drug Coated Balloon (DCB) for PTA: a device used to treat peripheral artery disease that had a potential additional reimbursement of $1,035.72.

BLINCYTO and the Lutonix Drug Coated Balloon were new in 2016. The first four items are in danger of being discontinued for 2017. A new technology/service cannot maintain the designation for longer than three years. The IPPS Final Rule for 2017 will contain the final determinations, but we will get a glimpse of the decisions sometime in April or May.

Laurie Johnson, MS, RHIA, CPC-H, FAHIMA, AHIMA-Approved ICD-10-CM/PCS Trainer

Laurie M. Johnson, MS, RHIA, FAHIMA is currently a senior healthcare consultant for Revenue Cycle Solutions, based in Pittsburgh, Pa. Laurie is an American Health Information Management Association (AHIMA) approved ICD-10-CM/PCS trainer. She has more than 35 years of experience in health information management and specializes in coding and related functions. She has been a featured speaker in over 40 conferences. Laurie is a member of the ICD10monitor editorial board and makes frequent appearances on Talk Ten Tuesdays.

Related Stories

  • CMS Releases 2019 Proposed Physician Fee Schedule
    CMS proposes to change physician evaluation and management (E&M) coding with a drastic overhaul. EDITOR’S NOTE: The following report first appeared on RACmonitor on July 13, 2018 After soliciting comments from many stakeholders in the last year, the Centers for…
  • Is All Airway Protection Acute Respiratory Failure?
    Document it right on the front end; avoid fighting a denial on the back end I was recently asked about a post from Hospital Performance regarding acute respiratory failure and airway protection (https://soundphysicians.com/blog/2018/06/20/from-the-appeals-desk-acute-respiratory-failure-part-1-2/), and I wanted to expand on what…
  • Incorporating Socioeconomic Status for Medicare Advantage: Addressing the Social Determinants of Health
    Accounting for socioeconomic factors is critical to the sustainability of healthcare. A recent blog headline in the American Council of Science and Health captured the healthcare industry’s attention. The headline read, Medicare Could Cover Food, Air Conditioners...Is Sex Next? The…