Christopher Crawford, MD FASMBS
Chair
Michael Cook, MD FASMBS
Co-Chair
John Scott, MD FASMBS
Executive Council Liaison
Members
Helmuth Billy, MD, Senior Past Chair
Matthew Brengman, MD FASMBS, Senior Past Chair
Francesca Dimou, MD FACS MS
Todd Foreman, MD FASMBS
Renee Hilton, MD (Access to Care Committee Co-Chair)
Maria Iliakova, MD
Margaret Inman, MD ACS (Access to Care Committee Co-Chair)
Crystal Johnson-Mann, MD MPH FACS FASMBS (Diverity & Inclusion Committee Liaison)
Ashutosh Kaul, MD, Immediate Past Chair
Wael Khreiss, MD
Ben Kocaj, MBA
Jason Krynicki
Peter C. LePort, MD FASMBS
Walter Lindstrom, JD
Jaime Ponce, MD FASMBS
Michael Seger, MD (Access to Care Committee Chair)
Don Jay Selzer, MD
Hany Takla, MD FACS FASMBS
Darren Tishler, MD FACS FASMBS (Access to Care Committee Co-Chair)
Ad Hoc
Chris Gallagher, Washington, D.C.
ASMBS Staff Liaison
Leslie Vinson
Mission
- To advocate for healthcare policy that ensures patients access to high quality prevention and treatment of obesity.
- To be a highly valued specialty society that serves the educational and professional needs of our diverse membership.
Description
The Insurance Committee bridges the gap between the details of insurance coverage and coding and the practicing surgeon. We focus on education of the surgeon and office administrative staff on the trends and changes in insurance coverage, coding and insurance access. The committee acts as a liaison between the ASMBS, insurers and CMS on the specifics of coverage for bariatric procedures. The committee seeks to identify new and commonly performed bariatric procedures and act as a champion for the development of CPT codes for effective and efficient reimbursement. Finally, the committee acts in concert with other committees of the ASMBS on acute and chronic access to care issues.
Objectives
- Increase reimbursement for bariatric and metabolic surgery
- Ensure appropriate CPT Coding
- Provide clarity on insurance issues to members
- Be a resource to ASMBS State Chapters, Access and Membership and their staff
Committee Goals
Short-Term
- Insurance Toolkit update for revisional and primary bariatric surgery
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Communicate with State Chapters and Access to Care Committees to identify local & national insurance concerns with respect to insurance issues that affect access to care with policy plan changes and other restrictions affecting bariatric surgery; current and ongoing issues include:
a. Bundled payment proposalsb. 3, 6, 9 and 12-month medically supervised preoperative weight management
c. Medically supervised preoperative weight management programs during which there can be no net weight gain as a condition of approval for bariatric surgery
d. Regional discrepancies regarding access to care and Medicare guidelines secondary to apparent "crosswalk" issues as they arise
e. Insurance policy changes
Mid-Term
- Webinar/videos/YouTube Channel
- Monitor AMA CPT or RUC issues that would involve bariatric surgery
Long-Term
- Prepare for bariatric CPT codes review when notified
- Assist the Access to Care Committee in negotiations between ASMBS and major carriers to modify overly restrictive plan language
- Maintain and update the Insurance Toolkit as needed
- Regularly evaluate and update the CPT and ICD-10 Codes for Bariatric Surgery for the website; develop communication/alerts to inform members about new codes
- Respond to member inquiries via the email “coding hotline” regarding insurance issues; update insurance FAQs and online information for the website
- Continue to respond to initiatives and requests for information by CMS
Specific Projects that Achieve Goals and Objectives
Short-Term
- Update of the Insurance Toolkit documents reviewed and approved
- Continued review of CMS changes affecting membership and the associated impact on access to care
- Continued communication between insurance carriers’ Medical Directors, ASMBS State Chapter Presidents, and ASMBS members
Mid-Term
- Continue to develop and pursue need for CPT Codes for bariatric issues as they arise and approach AMA CPT panel as required
Long-Term
- Access to Care Co-Chairs added to committee and Insurance Co-Chair added to Access to Care Committee
- Continued communications with State Chapters and Access to Care Committees on local and national Insurance issues
- Frequent and timely responses to insurance inquiries via the coding hotline – committee discusses and responds to approximately five member inquiries per month
2021-2022 Completed Projects
- Continued to be a valuable resource for members on coding and billing queries and helped resolve their issues
- Assisted the EC with the intragastric balloon placement code which was active in 2022
- Insurance Toolkit update for revisional and primary bariatric surgery complete May 2022