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VAD REIMBURSEMENT SESSION

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ISHLT will be conducting an educational session at the Annual Meeting in April in Prague regarding how to accommodate the recently implemented changes to MCS billing by CMS. This session will take place during the MCS Council Meeting. Look for details on date/time/location of the MCS Council Meeting in the 2012 April Links issue.

The US Center for Medicare and Medicaid Services (CMS) has proposed significant changes in reimbursement for transplant and mechanical circulatory support procedures. The ISHLT supports advocacy of its membership as well as for patient care and is developing a forum to educate US surgeons and HF cardiologists of these regulatory changes and of the requirements necessary to capture reimbursement of postoperative care at this year's 2012 ISHLT Scientific Meeting in Prague. In the spirit of the ISHLT, we will also devote a portion of the session to any new major MCS reimbursement issues outside of the US.

The following changes have been proposed by CMS:

  • A reduction in reimbursement for VAD implant procedures but allowances for reimbursement of VAD-related "critical care".
  • Effective Jan. 1, 2012, the physician payment policy for Ventricular Assist Device removal procedures will change. Payment values will be reduced and no longer include reimbursement for in-hospital and out-patient evaluation and management services. Payments could be reduced dramatically - up to 30 percent - unless you prepare for this change.

If you do VAD procedures, you are providing a substantial amount of critical care as well as in-patient and out-patient care, which are currently reimbursed automatically. However with these changes, those services must be processed in an itemized fashion for each patient. Accurate documentation of services provided requires surgical insight and is the surgeon's responsibility, and accurate documentation is critical for correct coding and ultimately correct reimbursement.

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Photo credit: Dmitry Bodrov, Prague At Sunset, Photos.com