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Advocacy Newsletter - June 14, 2012

Breaking TAVR news! Your ACC yesterday provided testimony before the U.S. Food and Drug Administration's (FDA's) Circulatory System Devices Panel of the Medical Devices Advisory Committee regarding expanding indications for use of the Edwards SAPIEN™ Transcatheter Heart Valve to include patients eligible but at high risk for aortic valve surgery and the transapical approach. The committee voted 11 -0 with one abstention in favor of expanding the indications. The Sapien system was previously approved last November for patients not considered surgical candidates for aortic valve replacement. Approval was limited to implantation using a transfemoral approach. John Carroll, MD, FACC, from the University of Colorado, Denver, and a member of The Society of Thoracic Surgeons (STS)/ACC TVT Registry™ Steering Committee, testified on the College's behalf. His testimony primarily focused on how registries like the STS/ACC TVT Registry can be leveraged to evaluate patient selection, procedure indications, peri-procedural outcomes and longitudinal safety surveillance and patient outcomes. Additional resources, including a video interview with Carroll and links to testimony, are available here. You can also visit the TAVR Resource Center for more on the topic, including links to clinical documents, news updates and the TVT Registry. In addition, the ACC and STS are holding a webinar, along with the Centers for Medicare and Medicaid Services (CMS), on Thursday, June 21 at noon ET. The webinar will focus on the recent CMS national coverage decision on TAVR, including heart team and hospital qualification requirements, and the STS/ACC TVT Registry.

New AUC released: Your ACC this week, in partnership with 10 other leading professional societies, released new appropriate use criteria (AUC) focused on peripheral vascular ultrasound and physiological testing. This newest set of AUC focuses on a total of 255 indications (with the inclusion of surveillance timeframes) where ultrasound and physiological testing is frequently considered. In addition to looking at the reasons for ordering these tests, they also focus on how frequently repeat testing is needed in clinical practice in light of the need for ongoing surveillance in some patients. "This is the first systematic and comprehensive evaluation looking at appropriate indications for vascular testing, such as ultrasound or functional testing," said Emile R. Mohler III, MD, FACC, chair of the writing committee. The AUC also outline key areas for research moving forward. A related report presenting AUC for vascular laboratory testing to evaluate venous circulation is expected to be released in late fall of this year. Share your thoughts on the newest criteria in the ACC in Touch Blog.

Matching Medicaid payments: In a letter submitted to CMS this week, the College expressed support of the proposal to increase Medicaid payments for primary care services to match local Medicare payment levels in 2013 and 2014 as required by the Affordable Care Act. According to the comments, "Medicaid payments in many states remain alarmingly low and many physicians who would like to offer services to these patients are financially unable to sustain their business with the current payment level." The College emphasized the importance of increasing payment for all primary care services provided by subspecialists of internal medicine and pediatrics in addition to generalists in those fields. The comments also noted how in many cases, particularly in the case of pediatrics, the cardiologist acts as the primary care physician because the chronic disease that led them to seek care from a specialist impacts all of their healthcare decision-making. An article in the latest issue of Cardiology magazine explores treatment for adult congenital heart disease patients, a population that would benefit from increased physician access. Read more here.

Don't get rejected! The deadline for the Version 5010 upgrade was Jan. 1, 2012 and the deadline for all HIPAA-covered entities to complete their upgrade to the Version 5010 electronic standards is June 30, 2012. Here are a few things to keep in mind for processing your Version 5010 claims, which should help avoid unnecessary rejections:

  1. ZIP Code: You need to include a complete 9-digit ZIP code for the billing provider and service facility location. You should work with your vendor to make sure that your system captures the full 9-digit code.
  2. Billing Provider Address: You need to use a physical address for your billing provider address. Version 5010 does not allow for use of a PO Box address for either professional or institutional claim formats. However, you can still use a PO Box as your address for payments and correspondence from payers as long as you report this location as a pay-to address.
  3. National Provider Identifier (NPI): You were previously allowed to report an Employer's Identification Number (TaxID) or Social Security Number (SSN) as a primary identifier for the billing provider. However, you are only allowed to report an NPI as a primary identifier for Version 5010 claims.

Visit the Version 5010 page on CardioSource for additional resources to help you prepare.

T-16 Days! The deadline for the federal E-Prescribing Incentive Program is also approaching. Hardship exemptions must be submitted through the Quality Reporting Communication Support Page no later than June 30. Get the details.

Are you eligible? Learn about the Electronic Health Record (EHR) incentive program, the federal government's newest incentive program, and how you can use it to your advantage to help improve patient care. A free webinar will be held on June 26 at 2 p.m. ET. Take this opportunity to ask CMS' subject matter expert Robert Anthony questions on the program's requirements. Hold your spot.

Get the tools you need!

  • Join Hospital to Home (H2H) on June 21 at 11 a.m. ET for a kick-off webinar on the "Signs and Symptoms" Challenge. Discover strategies for activating patients to recognize early warning signs and creating plans to address them. Register here.
  • PINNACLE Network is "Hammering it Home" on June 27 at 7 p.m. ET with a webinar focusing on essential tools for improving quality and practice performance. Sign-up now.