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ASIPP PODCASTS

Here are some of the available ASIPP® Podcasts:

  • A Discussion on Tolerance, Dependency, and PTSD with Dr. Joseph Cabaret and Dr. Kenneth Carle
  • Dr. Amol Soin And The Business Side Of COVID-19
  • Dr. Kevin Pho of KevinMD.com Reveals Terrific Insight And Ideas On The “New Norm” After The COVID-19
  • Andrea Trescot, MD Takes On The Subject Of Controlled Substance Management
  • ASIPP® Pod August 2019 – Distinguished Pain Leaders Prunskis, Prunskis, and Helm Discuss Issues That Face IPM
  • Miles Day Of Texas Tech Discusses Multiple Pain Management Topics

[ SELECT MORE ASIPP® PODCASTS ]

ASIPP MEMBERSHIP

Join ASIPP. Your Voice For Interventional Pain Management

Join the AMA or Renew Your Membership Today!

As of now, ASIPP has two positions available in the House of Delegates and all of the other memberships where they are available, even for the other societies within AMA. The American Medical Association (AMA) requires all societies to requalify for membership in the AMA House of Delegates (HOD) every five years. For ASIPP to retain our seat, the AMA requires that 20% of ASIPP’s physician members also be members of the AMA.

We encourage you to join or renew their membership in the AMA. Joining the AMA will further strengthen our specialty’s representation at the national level through the AMA House of Delegates, the AMA’s policymaking body, and strengthen our ability to meet the challenges in health care today with thoughtful, well-organized responses.

As a member of the AMA, you become part of the organization that unites physicians nationwide to tackle the major issues we all face: 47 million uninsured Americans, looming Medicare payment cuts, the need for medical liability reform. Membership also gives you access to a broad range of practice management resources and award-winning publications such as the Journal of the American Medical Association, AMNews, AMA Morning Rounds and the Archives journals.

Please take this opportunity to support the critical activities of ASIPP by joining the AMA today.  To join or renew the AMA, we encourage you to visit www.ama-assn.org or call (800) 262-3211.

The Saga of Amniotic Tissue Intraarticular Injections
is Coming to an End 

As you recall, ASIPP sent a news alert on October 29, 2020 focusing on Q codes and potentially fraudulent billing with intraarticular injections. ASIPP also sent a letter to Medicare MAC directors on November 3, 2020.

After the time of this alter, there have been incidences of fraud and abuse. Recently, a physician assistant went to trial in Fort Worth, TX and was convicted at this trial. Dr. Manchikanti provided the testimony for the Department of Justice highlighting the news alert from ASIPP.

The trial lasted 5 days. Subsequently, in less than 1 hour of deliberation, a jury convicted Ray Anthony Shoulders on all counts.

It is important to ASIPP and crucial to protect our physicians from fraud and abuse investigations, and at the same time, protect the Medicare program.

Read more

Important News Alert on Disastrous Reductions Due to a Computer Glitch for ASC Payments

On January 2nd, 2024, an ASIPP member from Texas brought to our attention a concerning issue, a 46.1% reduction in all ASC payments. This unexpected news prompted immediate action on our part. Acting swiftly, ASIPP and SIPMS reached out to CMS through the office of Cathy McMorris Rodgers, Chairman of the Energy and Commerce Committee, and CGS MAC Directors by ASIPP and SIPMS, seeking resolution.

CGS, led by Earl Berman, MD, promptly addressed the matter, successfully rectifying and adjusting the rates within 24 hours. All other MACs are still correcting.

Additionally, we want to inform you that a sample table has been generated for Kentucky’s McCracken County.

While Noridian, Novitas, NGS, Palmetto GBA, and WPS still reflect rates at 54% of the National Price, we intend to wait for 24 hours then contact them to expedite the resolution of this issue.

Update on efforts to stave off 3.37% Medicare cut to physician reimbursement to go into effect January 1, 2024

ASIPP would like to provide an update to our members on the latest efforts to stave off 3.37% Medicare cut to physician reimbursement that will take effect January 1, 2024.

Congressional Outreach
ASIPP has spent the past several months reaching out to congressional offices encouraging them to sign multiple letters that are being circulated by Reps. Miller-Meeks, Bera, Bucshon, and Schrier asking House and Senate leadership to prevent the 3.37% cuts from taking effect.

Currently, over 90 Members of Congress have signed the letter. In addition to this, letters are being sent directly to state representatives through VoterVoice. You can get involved and send your own letters by clicking on these links: Physician Letter, Patient Letter.

ASIPP has been in the forefront of requesting them to permanently increase reimbursements by 3.75% and permanently eliminate 3.37% cuts proposed this year.

In addition, ASIPP has been trying to eliminate the 2% sequester cut for physicians and facilities. You can see the letter to Speaker Johnson, Leader Schumer, Minority Leader Jeffries, and Minority Leader McConnell by clicking here.

Legislation
On the legislative front, ASIPP has been working with Congresswoman Miller Meeks (R-IA) on her legislation that was introduced on Friday, H.R. 6545. In addition to modifying the budget neutrality requirements at CMS – which, in theory, would allow the agency to fix the reimbursement cut without having to be revenue neutral – it also provides a conversion factor fix to lower the cut from 3.37% to 2.15%. This is consistent with the language that passed the Senate Finance Committee in November.

This bill was included in the House Energy and Commerce Full Committee markup. The bill passed the markup last night, Dec. 6, by a vote of 46 to 0.

Good news was announced by the AMA on December 7. Representatives Murphy (R-NC), Davis (D-IL), Wenstrup (R-OH), Panetta (D-CA), Bucshon (R-IN), and Burgess (R-TX) introduced the “Preserving Seniors’ Access to Physicians Act of 2023,” which would completely eliminate the 3.37 percent Medicare cut for physicians that goes into effect on January 1. This announcement can be found here.

Act Today
We have made great strides, but we have a lot of work ahead of us before the end of the year. We ask that you continue to take an active role by sending your letters and involving your patients in the letter writing campaign. Please take action by clicking on these links: Physician Letter, Patient Letter.

We will continue to update our membership on the progress and status of our efforts.

TRICARE changes its reimbursement policies in the final rule aligning with Medicare reimbursement methodology: Favorable to interventional pain management

August 23, 2023

Effective, October 1, 2023, TRICARE is adopting the Medicare reimbursement methodology for Ambulatory Surgery Centers (ASCs). Adoption of Medicare’s ASC reimbursement system will bring TRICARE reimbursement for ambulatory surgery care into alignment with the statutory requirement that payment methods for institutional care be, to the extent practicable, in accordance with the same reimbursement rules used by Medicare.

Changes to the TRICARE Reimbursement Manual 6010.58-M, April 1, 2015 edition, Change 72 (August 7, 2023), Chapter 9, Ambulatory Surgery Centers (ASCs), can be found at this here.

Please see Section 2 for a full description of the applicable changes. This change will create TRICARE and Medicare Fee-For-Service ASC reimbursement parity for all authorized ASC procedures. Consequently, access to care in the ASC setting for TRICARE beneficiaries will improve because of this change.

[ READ MORE ]

First Coast and Novitas Retire Proposed LCD on Nerve Stimulators for Chronic Intractable Pain

May 5, 2023 First Coast and Novitas Retire Proposed LCD on Nerve Stimulators for Chronic Intractable Pain After unrelenting pressure from the American Society of Interventional Pain Physicians (ASIPP), Florida Society of Interventional Pain Physicians, (FSIPP) (lead by Dr. Deborah Tracy), and other state societies, First Coast and Novitas have ruled to retire the proposed LCD, Nerve Stimulators for Chronic Intractable Pain (DL39406), related Local Coverage Article (LCA) (DA59190), Nerve Stimulators for Chronic Intractable Pain (DL39404), and Billing and Coding: Nerve Stimulators for Chronic Intractable Pain (DA59188).

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New Training Requirement for all DEA-Registered Practitioners on the Treatment and Management of Patients with Substance Use Disorders

April 18, 2023
On December 29, 2022, the Consolidated Appropriations Act of 2023 enacted a new one-time, eight-hour training requirement for all Drug Enforcement Administration (DEA)-registered practitioners on the treatment and management of patients with opioid or other substance use disorders (Medication Access and Training Expansion (MATE) Act). Click here to see the letter from the DEA.

Beginning on June 27, 2023, practitioners will be required to check a box on their online DEA registration form—regardless of whether a registrant is completing their initial registration application or renewing their registration—affirming that they have completed the new training requirement.

The deadline for satisfying this new training requirement is the date of a practitioner’s next scheduled DEA registration submission—regardless of whether it is an initial registration or a renewal registration—on or after June 27, 2023.

This one-time training requirement affirmation will not be a part of future registration renewals.

In response to this need, ASIPP has developed the virtual review course Controlled Substance Management Virtual Review Course: Medication Access and Training Expansion (MATE) Act. This virtual review course will be held on May 21, 2023. In addition to covering the required Curriculum to Meet MATE Act Requirements for DEA Licensing, it will also provide 10.5 AMA PRA Category 1 Credits™. Click here for the agendaClick here to register.

ASIPP Important Updates

Various Issues Found in Long-Term Outcomes in Use of Opioids,
Non-pharmacologic Pain Interventions, and Total Costs of Spinal Cord Stimulators Compared with Conventional Medical Therapy for Chronic Pain

March 28, 2023

Recently, Dhruva et al published an article on Long-Term Outcomes in Use of Opioids, Nonpharmacologic Pain Interventions, and Total Costs of Spinal Cord Stimulators Compared with Conventional Medical Therapy for Chronic Pain, showing no difference (click here to read the full article).
 
In response Drs. Manchikanti, Sanapati, and Hirsch sent a Letter to the Editor pointing out various issues related to this study and potential reasons (click here to read the letter).

Medicare Improperly Paid Physicians an Estimated $30 Million for Spinal Facet-Joint Interventions

March 22, 2023

The Office of Inspector General for the United States Department of Health and Human Services has conducted yet another audit on facet joint interventions, this is the third audit. There have been extensive audits from UPICs, SMRC, Nordian, and RAC, and MAC contractors.

In this study (click here to read), OIG looked at 120 sample sessions, with only 54 complying with Medicare requirements.
The overall estimated overpayments appear to be $29.6 million for facet joint interventions for an audit period of August 1 through October 31, 2021, with new LCDs in effect.

Obviously, there will be even more audits and there will be recoupment from multiple providers on these claims.

It is crucial that we follow appropriate algorithmic approach and utilize checklists to avoid such issues.

ASIPP Important Updates

Controversies on the Effectiveness of Spinal Cord Stimulation Continue

March 21, 2023

Controversies on the effectiveness of spinal cord stimulation continue. Recently Drs. Manchikanti, Sanapati, and Hirsch wrote a response to the JAMA article (click here to read the response), JAMA Randomized Controlled Trial Comparing Spinal Cord Burst Stimulation Versus Placebo Stimulation with Lack of Effectiveness (click here to read the full article).
 
Drs. Manchikanti, Sanapati, and Hirsch describe multiple issues that limit the generalizability of this randomized clinical trial, specifically in the United States.

Medicare Improperly Paid Physicians for Epidural Steroid Injection Sessions

March 10, 2023

The Office of Inspector General for the United States Department of Health and Human Services found that Medicare did not always pay physicians for epidural steroid injection sessions in accordance with Medicare requirements.

Read more: https://oig.hhs.gov/oas/reports/region7/72100618.asp

ASIPP Important Updates

ASIPP’s Recent Advocacy Efforts 

February 15, 2023

ASIPP has been actively addressing recent coverage issues through letter correspondence to various agencies. The issues and letters include the following: 

AIM published new guidelines effective 04/09/2023. Owned by Anthem, Inc (ANTM), the AIM guidelines are utilized by multiple insurers. ASIPP has addressed the guidelines with a comment letter on the guidelines for Appropriate Use Criteria: Interventional Pain Management. Our comments were related to paravertebral facet joint injection/medial branch nerve block/neurolysis/therapeutic facet joint interventions. Click here to see letter

We are requesting LCD reconsideration requests to all of the Medicare Contractors for the LCD covering Facet Joint Interventions for Pain Management. Click here to see letter. 

ASIPP immediate past president, Amol Soin, sent a letter to Cigna on February 7 addressing their Medical Policy Update on Peripheral Nerve Block Procedures (for trigeminal and occipital neuralgia) which considering them experimental, investigational, or unproven, with an efficacy date of April 18th, 2023. In the letter, we ask that the policy update restricting the use of peripheral nerve blocks be re-evaluated and modified. We recommended that these procedures continue to be covered and we find the characterization of these procedures to be experimental or investigational to be inaccurate.  Click here to see letter.

Sacroiliac Joint Injections and Procedures: A New LCD Effective 3/19/2023

February 8, 2023

CGS (L39383), Palmetto (L39402), WPS (L39475), NGS (39455), and Noridian (L39462 and L39464) jurisdictions, have issued SI joint injection policies:

Novitas and First Coast Services have not issued their policies nor have they participated in multijurisdictional committee and have not issued a policy. 

You can use this algorithmic approach whenever you see your patients by utilizing these checklists for each patient prior to performing epidural steroid injections and facet joint interventions. 

An Algorithmic Approach to Sacroiliac Joint Injections

New AIM Guidelines Effective April 9, 2023

AIM has published new guidelines effective 04/09/2023. AIM guidelines are utilized by multiple insurers. AIM is owned by Anthem, Inc (ANTM).

Click here to find what we have presented.

Congress Passes $1.7 Trillion Omnibus Spending Package, Proposing Medicare PAYGO Physician Pay Cut of 2% Beginning in January 2023 with Continuation of 2% ACA Sequester Cuts

The important aspects of Omnibus include proposed pay cuts of 2% in 2023 for physicians, a reduction from 4.5%, and in 2024, the cuts will increase to 3.5%. The Wall Street Journal described this as the ugliest Omnibus bill ever with a 4,155 page bill that most members will never read. This bill includes multiple provisions affecting healthcare providers:

1. Reduce the physician fee schedule cut from 4.5% to 2% for 2023 and 3.5% for 2024
2. Prevents the 4% statutory pay as you go sequester for 2 years
3. Provides extension of telehealth services for 2 years
4. The worst news is that:

  • There is no mention of 2% sequester cut from ACA. Consequently, the 2% sequester cut will continue. Obviously, this will result in 4% cut for physician fee schedule from 2022 (2% new cut + 2% sequester cut = 4%).
  • For facilities, sequester cut of 2% will be implemented through 2023.

Sample schedules are as follows:

To view the entire fee schedule go to the ASIPP members only website.

[ READ MORE

Anesthesia for Pain Management Procedures: CGS Confirms the Message ASIPP has been Giving Membership

ASIPP has been working on the issues concerning anesthesia for pain management procedures for a long time.

In the September 20, 2022 CGS News Publication, “Anesthesia for Pain Management Procedures,” CGS confirms the message ASIPP has been giving our membership:

Mild sedation is acceptable for all interventional procedures. Monitored anesthesia care is acceptable for radiofrequency neurotomy procedures. Otherwise, claims billed with moderate or deep sedation, general anesthesia, or MAC during a pain management procedure, other than radiofrequency, will be denied. Note: The entire claim will be denied—not just the sedation claim.

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United Healthcare Revises Epidural Injection Policy from 3 to 4 per Year, Based on the ASIPP Recommendation

Important news! United Healthcare’s new policy reverses the previous policy with a limit of three (3) epidural injections to the ASIPP recommendation of four (4) procedures per year. 

As you know, ASIPP has resolutely advocated for the change in the policy on epidural injection limits of three (3) per year through evidence-based presentations and communication. We first sent a letter on June 21, and they responded on June 27. Since then, we have continued with multiple other correspondences. Consequently, they published the new policy effective November 1, 2022, which now provides coverage for four (4) procedures.

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Onerous 10.4% Cut is Coming for Physicians, Compounded by an Escalating 9% Inflation, Equaling a 20% Cut: Act Now! Your Survival is at Stake

CMS has published the 2023 Physician Fee Schedule and it is worse than we expected. The conversion factor has been reduced by 4.4%. It will be reduced from $34.61 to $33.08, a decrease of $1.53. This will be added to the 2% sequester cut from ACA and 4% statutory PAYGO from the American Rescue Plan Act. This is equal to nearly a 20% cut when you combine this with inflation. Unless Congress acts, the total expected cuts are 10.4% from 2022, and 9.75% from 2021, starting January 2023. 

We encourage every ASIPP member to join us in the effort to contact every member of Congress. You can start by contacting the Senators and Representatives of your
district. It is essential that we act soon and participate in meetings with members of our Congress, as well as start a letter campaign involving physicians, providers, nurses, staff, and most importantly, the patients.

Please see the fact sheet (FACT SHEET) and sample
letters (SAMPLE PHYSICIAN LETTER) (SAMPLE PATIENT LETTER).

Link to submit patient letters: https://www.votervoice.net/ASIPP/campaigns/96404/respond

Link to submit physician letter: https://www.votervoice.net/ASIPP/Campaigns/96405/Respond

[ READ MORE

An Algorithmic Approach & Checklist to
Epidural Steroid Injections

After being made aware that several physicians are being audited, we are concerned that some members are having difficulty conforming to the LCDs and medical policies. In response, ASIPP is providing you with an algorithmic approach and a checklist.

Regardless of the opinions you hold and the evidence that exists, it is crucial to follow the LCDs. Whatever is quoted in the LCD or medical policy is final and we must abide by those.
See: https://asipp.org/icd-10-codes/

Any changes you believe are warranted should be presented for consideration through a redetermination process for LCDs or medical policies for private insurers or Medicaid. They can be submitted during the next cycle of revisions.

You can use this algorithmic approach whenever you see your patients by utilizing these checklists for each patient prior to performing epidural steroid injections and facet joint interventions.

Click here for Documentation, Indications, Limitations, Utilization, and a Checklist for Epidural Steroid Injections.

An Algorithmic Approach & Checklist to
Facet Joint Interventions

The algorithmic approach describes diagnostic block procedure, as well as therapeutic interventions.
Click here for Documentation, Indications, Therapeutic Facet Joint Interventions, Limitations, and a Checklist for Facet Joint Interventions.

IMPORTANT NEWS!
Percutaneous Adhesiolysis Is Now Covered in All States

Percutaneous adhesiolysis has faced multiple issues related to coverage in the past few years. Initially, Noridian issued a noncoverage decision, followed by Palmetto issuing an experimental procedure decision.

Since then, we have incorporated into discussions on epidural LCD. While it was discussed in epidural LCD, it was not issued in the final consideration. We continued our efforts for coverage of this procedure and general consensus was that they all will be covering as any other Medicare services in the absence of a particular policy. We continue to face questions with Palmetto and Noridian.

After many years of advocacy, we have finally succeeded in getting coverage for this important procedure in all states, including all Palmetto and Noridian states in the United States.

We are very grateful to the Multijurisdictional Committee that convened considering epidural injections on 2/11/2021 for considering percutaneous adhesiolysis. We are also grateful to the Medical Directors of Palmetto and Noridian MACs for their prompt response.

Enclosed, please see the letters written to Palmetto and Noridian and the responses from Palmetto and Noridian.

Read More…

ASIPP, IPM, and Patient Response to the Proposed CDC Guidelines

The 2016 CDC opioid guidelines were aimed at primary care providers, but many state boards mandated them by law, resulting in tremendous needless suffering and exacerbating the illicit opioid epidemic with causation of needless deaths. These guidelines not only restrict opioid prescriptions, but also have restricted almost all interventional techniques to reduce access and sending patients to the streets for illicit opioids. With the new guidelines, these unintended consequences, including overdoses, deaths, and access limitations will continue.

The guidelines should call for a multidisciplinary approach to chronic pain that includes multiple modalities incorporating the role of interventional pain management for diagnosis and treatment.

ASIPP UPDATES

ASIPP is pleased to announce the publication of the Comprehensive Evidence-Based Guidelines for Epidural Interventions in the Management of Chronic Spinal Pain. In preparation of the guidelines, an extensive literature review was performed. The 210-page guidelines contains 33 figures, 48 tables, 1,345 references and has 60 authors.

In addition to the review of multiple manuscripts in reference to utilization, expenditures, anatomical and pathophysiological considerations, pharmacological and harmful effects of drugs and procedures, for evidence synthesis, we have included 47 systematic reviews and 43 RCTs covering all epidural.

[ READ MORE ]

ANNOUNCEMENTS

Members Only Resource

Doctor Finder allows you to search for an ASIPP® Member Interventional Pain Physician anywhere in America by name or by location. It’s quick and easy.

Since this malpractice insurance program officially launched in November 2018, ASIPP has signed up hundreds of providers with an average savings of 30%. This is professional liability insurance tailored to our specialty and will stand up for us and defend our practices.

Curi is a full-service advisory firm that serves physicians and their practices. Their valued advice is grounded in your priorities and elevated in your outcomes. They are driven by a deep understanding of your specific circumstances in medicine, business, and life. To read a few important points to keep in mind about the program, including discounts, administrative defense, cyber coverage, aggressive claims handling, and complimentary risk management CME activities, click here.

PainExam is proud to announce that it now offers preparation for the ABIPP Pain Management Board Exam! In addition, PainExam has now collaborated with ASIPP to offer Virtual Learning programs.

[ READ MORE ]

PainCast, the pain management network, has collected years worth of information on the history and processes of the pain management specialization and transformed it into a virtual library of videos, journals, articles, podcasts, and more – all at your fingertips.

Essentials of Regenerative Medicine in Interventional Pain Management is a book to bring concise, collective, and comprehensive information to interventional pain physicians practicing regenerative medicine with its applications in managing chronic pain.

[ READ MORE ]

ASIPP has formed a partnership with Henry Schein and PedsPal, a national GPO that has a successful history of negotiating better prices on medical supplies and creating value added services for the independent physician.

[ READ MORE ]

ASIPP is now offering our members the benefit of a unique revenue cycle management/billing service. We have received a tremendous amount of interest in the ASIPP billing and coding program.

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