ACS Advocacy Brief: July 28

Federal Grants Are Now Available to Develop Military-Civilian Partnerships in Trauma Care

The Department of Health and Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response has posted the grant application for the Military Civilian Partnership for the Trauma Readiness Grant program to its grants.gov website. Grants for up to $1 million per year for 3 consecutive years are available for major trauma centers who are able to train entire military trauma teams and for up to $100,000 per year for centers who will accept individual military trauma care providers. The deadline for applications is Wednesday, August 31.

Grant funding will support the introduction of military trauma care teams and providers into civilian hospitals to gain exposure to treating critically injured patients and increase readiness for when these units are deployed. Likewise, best practices from the battlefield are brought home to further advance trauma care and provide greater civilian access.

The Role of ACS Advocacy in MISSION ZERO

The grant program was established by the Military Injury Surgical Systems Integrated Operationally Nationwide to Achieve ZERO Preventable Deaths Act, also known as the MISSION ZERO Act, and was authorized as part of the Pandemic All Hazards Preparedness and Advancing Innovation Act of 2019. The MISSION ZERO grant program was funded at $2 million for the first time in 2021 thanks in part to the direct advocacy efforts of the ACS, its Committee on Trauma (COT), and the continued support of and collaboration with the Military Health System Strategic Partnership American College of Surgeons).

The MISSION ZERO Act stemmed from a 2016 National Academy of Sciences, Engineering, and Medicine report, “A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury." The COT was instrumental in developing the report recommendations.

The initial $2 million in grant funding was a crucial step in creating military-civilian trauma care partnerships and improving patient care. Now the advocacy priority is to ensure that the program remains funded annually.

House Committee Advances Legislation to Ease Prior Authorization

This week, the House Ways and Means Committee advanced the Improving Seniors’ Timely Access to Care Act. The ACS-supported legislation, championed by Reps. Suzan DelBene (D-WA), Mike Kelly (R-PA), Ami Bera, MD (D-CA), and Larry Bucshon, MD (R-IN), in the House and Sens. Roger Marshall, MD (R-KS), Kyrsten Sinema (D-AZ), John Thune (R-SD), and Sherrod Brown (D-OH) in the Senate, would facilitate electronic prior authorization, improve transparency, and increase Centers for Medicare & Medicaid Services (CMS) oversight of how Medicare Advantage (MA) plans apply prior authorization requirements.

Earlier this year, the HHS Office of Inspector General (OIG) released a report indicating that MA organizations (MAOs) sometimes delayed or denied beneficiaries access to services because of prior authorization disputes. These postponements and denials occurred even when the requests met Medicare coverage requirements. In addition, the report revealed that MAOs denied providers payment for some services that met both Medicare coverage rules and MAO billing rules. The OIG report highlights that denying requests meeting Medicare coverage rules may prevent or delay beneficiaries from receiving medically necessary care.

The findings of this report emphasize the need to streamline the MA prior authorization process and bring more transparency and oversight to the MA program. 

This bipartisan legislation has the support of more than 300 representatives and 37 senators and has been endorsed by more than 500 organizations.

Bulletin Article Explains Why Surgeons Voices Make a Difference on Capitol Hill

The fruition of the MISSION ZERO military-civilian trauma care improvement grant program described earlier in this Advocacy Brief is just one example of how a surgeon’s expertise and dedication to advocacy can lead to success in meeting the ACS’s legislative goals.

In each of the last 2 years, surgeons have come together through SurgeonsVoice and the ACS-led Surgical Care Coalition to halt the most severe cuts for Medicare reimbursement and, consequently, protect patient access to care. And, with CMS’s recently released proposed rule that would again bring harsh payment cuts in 2023, surgeons need to unify once again.

As Patrick V. Bailey, MD, MLS, FACS, Medical Director of ACS Advocacy, wrote in a June Bulletin article, a surgeon’s voice is critical in making progress for any legislative priority.

Two key points Dr. Bailey noted:

• Don’t be offended if you receive an impersonal response or if the legislator expresses views that differ from yours. The purpose of sending a grassroots message to a congressional office is to make sure your voice is heard.
• Build an effective relationship with your legislators when they are back home in the district. Get to know your legislators, as well the district director, district staff, and health policy staff, who are essential advisors to your elected officials. Become their trusted source of information on how public policy affects patient care. 

“Fellows made a real difference last fall in mitigating the Medicare payment cuts, and they can make a difference on whatever issues may be next on the horizon,” he wrote.

Register Now for 2022 On-Demand General Surgery Coding Workshops

To ensure quick prior approvals and more effective appeals, you and your staff need accurate and updated coding information. With on-demand CPT (Current Procedural Terminology) courses, the ACS has the information you need.

The ACS has partnered with KarenZupko & Associates to offer on-demand courses to help you and your coding staff stay on top of changes in CPT coding and documentation. These 60−90 minute on-demand course offerings allow you to learn anywhere at your own pace.

The courses will help surgeons, practice administrators, managers, coders, and reimbursement staff ensure accurate, consistent, and complete coding.

On-demand courses available include:

• Office E/M Coding for Surgeons
• Avoid Denials! Code Hospital Services Correctly!
• Critical Care Coding and Documentation – 2022 Update
• Office Procedures – Document and Code Them Right

Each course is accredited for AMA PRA Category 1 Credits™, and discounts are available for team members or practice employees of ACS members.

Don’t give health plans a reason to decline payment. Using old codes, being unaware of the recent rule changes on split/shared visit billing, and misusing critical care coding and billing are all expensive mistakes.