Regulatory Issues Require Advocacy Efforts, Member Assistance

August 4, 2011


Dr. Bruce Sigsbee

Advocacy for neurologist members is more than time spent on the Hill. One of the major areas of effort focuses on coding, technology, and CMS regulations. Over the years, totally inappropriate suggestions have surfaced for neurology. One of the most prominent in my experience was that neurologists document examination of the liver in all patients because of the risk of Wilson's disease! While we all agree that the current documentation criteria have nothing to do with a competent or even superior neurologic assessment, it could be far worse.

For this month's President's Column, I invited Neil A. Busis, MD, FAAN, chair of the Medical Economics and Management Committee, to summarize the committee's advocacy efforts below.

Bruce Sigsbee, MD, FAAN
President, AAN

Neil A. Busis

The Medical Economics and Management Committee (MEM) of the AAN champions the quality practice of neurology by improving the economic and regulatory environment for members through education and advocacy. MEM has three subcommittees:

  • The Coding Subcommittee advocates for appropriate coding and reimbursement policy for neurologists and educates members on how to code correctly. The subcommittee works with appropriate national and international organizations to assist with the maintenance and development of proper diagnosis (ICD), procedure (CPT), evaluation and management (E/M), and supply (HCPCS) codes used in the practice of neurology.
  • The Payment Policy Subcommittee's mission is to foster positive working relationships by working together with the health insurance industry toward high quality patient-centered health care solutions. The group strives to establish itself as a primary point of contact for members and payers seeking definition and development of medical policies that affect neurologic care.
  • The Practice Management & Technology Subcommittee helps AAN members use health information technology (HIT) to enhance patient care and physician efficiency in care, educates AAN members about how to run a good business and simplify their practice, and supports increased involvement of neurologists' office staff in AAN activities.

In addition, the Business and Research Administrators in Neurology Society (BRAINS)—a group of both academic and private practice administrators and managers with a focus on working together to advocate for change and identify issues of importance to administrators and managers in neurology—engage frequently with MEM.

MEM often collaborates with the AAN's advocacy team including the Government Relations Committee, most recently on our continuing efforts to advocate for appropriate reimbursement for cognitive services. Marc Raphaelson, MD, and staff attended a cognitive specialty coalition meeting in May with the Centers for Medicare & Medicaid Services (CMS). The Academy is closely following proposed rules from CMS for Accountable Care Organization (ACO) formation. MEM held a webinar with the CMS point person on ACOs before submitting comments and is developing resources to educate members. MEM also is engaging in discussions with private insurers about their new payment and care delivery models.

MEM is committed to providing timely and convenient ways for AAN members to learn about coding and reimbursement activities. So far in 2011, 617 participants have participated in five live practice webinars, already exceeding last year's total of 405 participants. MEM and BRAINS will offer three practice courses at the AAN 2011 Fall Conference, October 21 to 23, in Las Vegas, and a wide range of courses at the 2012 Annual Meeting in New Orleans. Three MEM representatives completed the Online Faculty Course and Workshop in May 2011. Based on their training, they will each develop an online CME program for the membership by the end of the year and then mentor the next group of faculty.

Coding Subcommittee members are active in developing and refining diagnosis and procedure codes and advocating for fair reimbursement for services provided by neurologists. Current efforts include proposing revisions to the EMG and nerve conduction codes to follow a CMS mandate, revising the Academy's model policy on intraoperative monitoring and redefining how physician work intensity, a key component of reimbursement under the Resource-Based Relative Value Scale, is measured.

The Payment Policy Subcommittee hosted its annual joint meeting of state society leaders and neurology Carrier Advisory Committee (CAC) representatives in Honolulu. For the first time, a local Medicare Carrier Medical Director, an ombudsman, and a representative from the local Blue Cross Blue Shield plan all attended the meeting to discuss upcoming health care delivery and payment changes in the public and private sector as a result of health care reform implementation. Payment Policy facilitates AAN input on coverage policy for private insurers and Medicare. In 2010, AAN reviewed and provided written input on 51 medical policies from five different national insurers. The subcommittee is on track to exceed that number in 2011. Some insurers are now providing feedback reports on policy reviews. According to the 2010 report from WellPoint, the AAN had an overall response rate of 67 percent, compared to the overall specialty medical society response rate of 35 percent. The AAN also responds more quickly—an average of four days—compared to the total society average.

In early 2011, the Practice Management & Technology Subcommittee developed an elaborate campaign to raise member awareness and preparedness with upcoming Medicare incentive programs' penalties and incentives. Since mid-April, more than 350 one-on-one discussions have occurred between AAN members and staff regarding the electronic prescribing (eRx) and electronic health record (EHR) incentive programs. The AAN has formalized a partnership with AmericanEHR Partners, a website that will provide neurologists with the necessary tools to identify, compare, and implement EHRs and other health care technologies. As the number of members contacting AAN looking for guidance on EHRs has steadily increased, MEM looks forward to this new partnership to assist members in preparing to select and implement EHRs.

You can learn more about the Academy's efforts to advocate for improved cognitive reimbursement in the August issue of AANnews® and about previous and upcoming practice webinars on

Neil A. Busis, MD, FAAN
Chair, AAN Medical Economics and Management Committee