Michael Cook, MD FACS FASMBS
Chair
Maria Iliakova, MD
Co-Chair
Don Selzer, MD
Co-Chair
Helmuth Billy, MD
Executive Council Liaison
Members
Helmuth Billy, MD, Senior Past Chair
Matthew Brengman, MD FASMBS, Senior Past Chair
Yijun Chen, MD
Christopher Crawford, MD FACS FASMBS
Francesca Dimou, MD FACS MS
Adrian Dobrowolsky, MD FACS
Philip Gachassin, MD MHCM FACS FASMBS (Access to Care Committee Co-Chair)
L. Renee Hilton-Rowe, MD (Access to Care Committee Chair)
Crystal Johnson-Mann, MD MPH FACS FASMBS (Diverity & Inclusion Committee Liaison)
Wael Khreiss, MD
Jason Krynicki
Peter LePort, MD FASMBS
Walter Lindstrom, JD
Jaime Ponce, MD FASMBS
John D. Scott, MD FACS DABOM FASMBS, Past EC Liaison
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
2023-2024 Committee Goals
- Publish the Ideal Bariatric Policy
- Update 2015 National Correct Coding Initiative Enacts New PTP Coding Edit For Primary Bariatric Surgery and Paraesophageal Hernia Repair
- Respond to member inquiries via the email “coding hotline” regarding insurance issues; update insurance FAQs and online information for the website
- Communicate with State Chapters and Access to Care Committees to identify local & national 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 proposals
b. 3, 6, 9 and 12-month medically supervised preoperative weight management programs and programs during which there can be no net weight gain as a condition of approval for bariatric surgery
c. Regional discrepancies regarding access to care and Medicare guidelines secondary to apparent "crosswalk" issues as they arise d. Insurance policy updates
e. Negotiations between ASMBS and major carriers to modify overly restrictive plan language - Maintain and update the Insurance Toolkits as needed
- Monitor AMA CPT or RUC issues that would involve bariatric surgery
- Prepare for bariatric CPT codes review when notified and regularly evaluate and update the CPT and ICD-10 Codes for Bariatric Surgery for the website
- Continue to respond to initiatives and requests for information by CMS
Specific Projects that Achieve Goals and Objectives
- Ideal Bariatric Policy – final draft in progress
- Update 2015 NCCI Enacts New PTP Coding Edit For Primary Bariatric Surgery and Paraesophageal Hernia Repair – final draft in progress
- Review Bariatric Insurance Coding Toolkits for changes yearly
- Frequent and timely responses to insurance inquiries via the coding hotline – committee discusses and responds to approximately 2 member inquiries per month
- 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 members, ASMBS members, and Access to Care Committees on local and national Insurance issues
- Continue to develop and pursue need for CPT Codes for bariatric issues as they arise and approach AMA CPT panel as required
- Access to Care Co-Chairs added to committee and Insurance Co-Chair added to Access to Care Committee
2022-2023 Completed Projects
- Continued to be a valuable resource for members on coding and billing queries and helped resolve their issues
- Insurance Coding Toolkit, May 2022
- Final drafts of Ideal Bariatric Policy and Update of 2015 NCCI Enacts New PTP Coding Edit For Primary Bariatric Surgery and Paraesophageal Hernia Repair in progress