Payment Shifts: Expect reimbursement structure changes ahead, policy experts say

So far this process was used with success when the AAO-HNS was able to convince United Healthcare to change its guidelines on reimbursement for rhinoplasty, septoplasty and repair of vestibular stenosis, he said.

“It is important for members to realize the power of the AAO-HNS, and its ability to deal with the large insurance companies and get them to listen to us,” he said. He urged members having trouble with reimbursement issues to seek out the AAO-HNS.

He also urged members to get involved in the process and volunteer their time. “The only way we can get this to work is to get members involved on multiple levels, whether it is on the board of governors, AAO-HNS committees, subspecialty committees or state or local societies,” he said.

Another way that members can get involved is to participate in and appropriately complete the surveys sent out by the American Medical Association (AMA) on current procedural technology (CPT) codes. “It is critical that members step up and respond to these surveys, because the AMA bases the value of procedures on these survey responses,” he said. He also emphasized the importance of completing the surveys by providing all the details requested. “We need members to respond to these surveys so that we get a significant response rate as well as appropriate responses,” he said. “That is a big issue. If members do not do these surveys or do not do them appropriately, our reimbursement will suffer.”

New Technology Pathway

Another new initiative that works with the 3P committee is the New Technology Pathway. Developed and approved by the AAO-HNS in 2010, this initiative provides a starting point and structure for the AAO-HNS’s CPT and relative value scale update committee (RUC) processes. According to Dr. Dillon, who is also the AAO-HNS CTP/relative value unit (RVU) Committee Chair, the new pathway “helps ensure that the AAO-HNS can efficiently develop new CPT codes that are appropriately valued and reimbursed.”

Instead of relying on endorsement by a single or group of physicians for a new technology, the New Technology Pathway creates a process by which new technology is reviewed at the organizational level and then possibly supported by the AAO-HNS, Dr. Setzen explained. (See “New Technology Pathway” for an outline of this process.)