Monday, June 15, 2015

CMS Issues National Coverage Decision for Pacemakers Dangerous To Patients

Who needs the Independent Payment Advisory Board to limit indicated care for patients when you have the Center for Medicare and Medicaid Services (CMS)?

Today I learned that CMS has issued a National Coverage Decision (NCD) for pacemakers effective 6 July 2015 that would restrict pacemaker implants to patients with "non-reversible symptomatic bradycardia" and require a so-called "KX" modifier to be added to codes for patients needing pacemakers.

That's right, even patients with asymptomatic complete heart block would not be covered.  Patients with asymptomatic Mobitz Type II heart block wouldn't be covered either.  Even though every piece of medical literature has supported the benefits of pacemakers in these indications, it seems doctors will be left with no choice but to lie in their documentation about patient symptoms to assure Medicare payment, or risk the government refusing to pay for their patients' medically indicated care.

Of interest is the fact that the change request for the new policy references a section of CMS’ claims processing manual. (The red italicized print in CR 9078) However, that section is now suddenly absent from the actual manual.

The Heart Rhythm Society and the American Medical Association (who forwarded this rule change) has been suprising silent on this new decision that was recently forwarded to our nation's hospitals and failed to included "exceptions" to their rules as part of their transmission. As of this morning, no mention of this transmittal has occurred on their website that I could find.

Practicing cardiologists and cardiac electrophysiologists everywhere should be outraged that such a document was circulated to Medicare billing coders everywhere, but not forwarded to US physicians given its implications to patient care. 

I have no doubt Medicare monies will be saved when people die as a result of this transmitted coverage decision as it currently exists. But we should ask ourselves who is responsible for such negligence on behalf of our patients?


1930 PM CST - Link fixed (h/t to @drjohnm)


Anonymous said...

Is there an third option for patients who can pay out of pocket? I know it's not an option for everyone, but it should be an option for some.

This would be a lot easier if medical bills resembled reality, of course.

For the rest of us (who can't buy a pacemaker out of pocket), we get what we voted for.....

Anonymous said...

The 'Deadly Fox' is in the 'Henhouse', Dr! That is my contention. I have followed the trail of blood back to the coop, myself.
I have thoroughly investigated this mess. I suggest you contact Senator Grassley in Iowa. His office may be concerned with the organizations involved and the implications to healthcare. He needs to hear from you and everyone else affected.
We see this in endocrine management, as you know, particularly diabetic patients who often cannot get anything they need to properly measure and control glucose.
Or the costs are prohibitive to many. The conditions for coverage/reimbursement are getting worse. The co-morbidities start developing or worsen and they end up at your doorstep to find that even there, with you in the cardiology section, they can't get help! The emergency rooms don't do anything either or can't handle it.
Who is advising the CMS on all these issues? This is total insanity and it leads to mass death. CMS and their advisory needs to be put under review immediately. Patients lives matter!

Anonymous said... may have found these relevant links already ...

Anonymous said...

Is the implication that this is the fault of the Democrats?

Well, I look forward to the Republicans opening up their wallets!


Anonymous said...

If you ask me, CMS decision on pacemakers appears to be another petulant response of this administration to the inversion tactic of Medtronic taking their corporate headquarters to Ireland to avoid taxes. This administration would be so brazen to use the safety of the elderly as a fulcrum against presumed corporate non adherence.

Anonymous said...

Re: MDT's intentions to repatriate overseas money via inversion.
Interesting. Perhaps NCD 8525 w/ implementation Aug 13, 2013/effective date "TBD" might preclude the government targeting Medtronic...unless the government had privileged information/or MDT was in private talks with the government to push tax reform. It might fit. (Btw GE is bringing $36 billion home with $6 billion tax bill.)
CR9078 implementation: Tangled or twisted the end result is the same. No good.
Senator Elizabeth Warren is on the committee for aging/has some influence over Medicare. She claims DC is so conflicted and the bureaucracy so corrupt. Make her work.
IF NQF advised CMS (or vice versa) on this through one of their famous third party studies there is a place on their website to raise concerns. Or just call and voice strong opposition. Have them talk to CMS for you. If you don't know how to speak with them at NQF they have a publication defining their unusual terms. They call their language "NQFSpeak". I did not make that up!

Anonymous said...

HRS must have known this was coming. Why aren't they speaking up? How many appropriate pacers will get denied payment now?