FSPMR - Florida Society of Physical Medicine & Rehabilitation
FSPMR - Florida Society of Physical Medicine & Rehabilitation
FSPMR - Florida Society of Physical Medicine & Rehabilitation


2012 Archives

November 5, 2012

Practice Alert - CMS Final Rule on CRNAs Scope of Benefit

On November 1st the Centers for Medicare & Medicaid Services (CMS) gave a final ruling which will take effect on January 1, 2013. CMS opined that certified registered nurse anesthetist (CRNA) will be covered for “anesthesia services and related care”, where the scope of “related care services” brings to question the expansion of CRNAs to include chronic pain management services.

CMS concluded that they are not able to ascertain the appropriateness of CRNA training in chronic pain management. They responded that chronic pain management is an evolving field and would defer to the individual sate’s definition of CRNAs scope of practice laws to determine allowable coverage.

For the full text of the ruling please visit http://www.ofr.gov/OFRUpload/OFRData/2012-26900_PI.pdf.

Rigoberto Puente-Guzman, MD
FSPMR President






Oct 17, 2012

Meningitis Outbreak Update

The Centers for Disease Control and Prevention (CDC), local health departments and the Food and Drug Administration (FDA) continue their investigation on the New England Compounding Center (NECC) products. Initial findings identified contaminated methylpredinsolone acetate as the source of the fungal meningitis outbreak post epidural steroid injections. Now other NECC products including another injectable steroid, triamcinalone acetonide, cardioplegic solutions and injectable ophthalmic drugs used in surgery are under further scrutiny. CDC and FDA recommend clinicians to stop the use of any NECC products.

According to CDC as of October 17 there has been 13 cases reported in Florida and 3 deaths.

CDC & FDA recommend that patients who have received treatment with one of the above NECC products who feel ill, even if mild symptoms should contact their physicians. Remember, that this form of fungal meningitis is not contagious.

Read the Entire Article>

Oct 7, 2012

Fungal Meningitis Outbreak cases linked to spinal injections.

As most are aware by now, on Oct 5, 2012, the Centers for Disease (CDC) and the Food and Drug Administration (FDA) announced a voluntary recall of New England Center (NECC) compounded products, as a result of an outbreak of meningitis among patients who had received epidural steroid injection thought to be from the contaminated medication (Methylprednisolone Acetate (PF) 80 mg/ml Injection: Lot #05212012@68, BUD 11/17/2012; Lot #06292012@26, BUD 12/26/2012; Lot #08102012@51, BUD 2/6/2013), and by October 3rd all product preparations for intrathecal administration by NECC where recalled. Investigation is ongoing. According to CDC the lists of Healthcare Facilities which have received Lots of Methylprednisolone Acetate (PF) Recalled from New England Compounding Center include: http://www.cdc.gov/hai/outbreaks/meningitis-facilities-map.html.

The first reported case of meningitis was on September 21..... Read the Entire Article>

Blue Cross Blue Shield of Florida Provider Appeals Process Overview (120004)
Effective 08/13/2012

BCBS of Florida has posted a notification on its "Provider Appeals Process Overview." To view the appeals process, click here.

2013 NCS Code changes

According to recent AANEM news the CMS (Centers for medicare & Medicaid Services) in addition to changing three new needle electromyography (EMG) codes encounter this year (95885,95886,95887), in 2013 also plan to change nerve conduction studies (NCS) from 3 to 7 codes with 1-4% reduced in reimbursement. We will keep you informed as more information comes forward.

ICD-10 Update

As of August 24, 2012 latest release from the CMS office, the Department of Health and Human services (HHS) announced a one year delay on conversion from the ICD-9 (containing 14,00+ codes) to ICD-10 (containing 68,000+ codes) compliance from October 1, 2013 to October 1, 2014.

Although ICD-10 deadline has been postponed it is critical to plan and asses for the impact this change will have in your practice. From recent conference on “Transition to ICD-10” at the FMA conference presentation last July, the estimated cost for transition to ICD-10 codes for a small practice is about $43,000, Medium size practice $285,000 and large practice $2.7 million (based on 2008 dollar value). It is recommended to have a 6 month of credit, to mitigate cash flow problems when billing gets delayed, costs for training providers and staff, process analysis, change in super bill, IT software and associated costs, increase in documentation cost, and other expenses. You will need to keep a dual system for ICD-9 and ICD-10 to be able to work with old AR accounts. The new ICD codes will be implemented by all insurances except Workers Compensation.

At the July 2012 FMA House of Delegates Medical Economic Committee Resolution 12-406 was passed to adopt, which is aimed at eliminating ICD-10 implementation.  At this point, in this author’s opinion, it is too early to tell if ICD-10 codes will survive. There is even talk of a new ICD-11 system being developed.

REMS Coming Down the Pipeline

On July 9, 2012 the FDA approved a Risk Evaluation and Mitigations Strategy (REMS) for extended release/long acting (ER/LA) opioid analgesics for the purpose of decreasing the risk of prescription drug misuse, abuse and misprescribing.  It covers about 35 branded and generic drugs that contain hydromorphone, morphine, oxycodone, oxymorphone, tapentadol, transdermal systems (fentanyl and buprenorphine) and methadone. The drug manufacturers are working to provide and promote essential safety education that includes prescriber training, a patient counseling document, and Medication Guides that will be unique to each ER/LA opioid analgesic product.  Key components of the REMS system will include: Training for prescribers; Updated medication guide and patient counseling document: and assessment and auditing.  The first FDA approved REMS-compliant training is expected to be available around March of 2013, funded by the ER/LA opioid analgesics REMS companies.

For more information please visit the FDA web site.