Top Takeaways: First Friday Clinician Outreach Meeting, February 7, 2020

By Policy and Advocacy Brief posted 02-12-2020 09:15


The top takeaways from the Centers for Medicare & Medicaid Services (CMS) February Clinician Outreach Meeting focused on the Open Payments Program updates, updated Medicare coverage guidelines related to acupuncture for chronic low back pain, and stakeholder feedback on ways to improve the Claims Appeals Process.

Open Payments Program Update

CMS currently is conducting an annual refresh of Open Payments Program data. The new data will be published on or by June 30. If a clinician is not registered already in the Open Payments system, CMS recommends that they do so as soon as possible. The next dispute period opens on April 1. CMS will be hosting a National Provider Call on March 19 from 2:00-3:00 p.m. This agency will discuss other opportunities to learn about the Open Payments Program. Details for participating in the call will be sent out soon.

Coverage of Acupuncture for Chronic Low Back Pain

Medicare coverage of acupuncture treatments began January 21. Here are the qualifying criteria:

  • The pain has lasted 12 weeks or longer, with no identifiable cause, and is not associated with surgery or pregnancy.
  • Only 20 treatments are payable per year.
Listening Session on the Claims Appeals Process

CMS has several initiatives aimed at improving provider experiences in the claims appeals process. The agency is providing stakeholders a forum to share their ideas and recommendations on process changes and improvements at the first two levels of appeal. The goal is to reduce burden at the Administrative Law Judge (ALJ) level of appeal by improving procedures before reaching the ALJ level. It is important to remember that CMS is limited as to the changes they can make due to strict existing regulations. Comments from participants included the following:

  • When we get a redetermination back, the information that we had provided when requesting the reconsideration usually is not addressed.
  • Provide the credentials of the nurse reviewers. Level 2 reviews usually do not have this information.
  • We feel that most first level appeals are automatically denied.

The next Clinician Outreach meeting is scheduled for Friday, March 6 at 1:30 pm.

Learn more about the Open Payments Program.