The North American Spine Society (NASS) has just announced new coverage recommendations for four procedures and treatments: Coccygectomy, DNA-Based Scoliosis Test, Electrical Stimulation for Bone Healing and Facet Joint Interventions. The NASS Coverage Committee, led by President Christopher Bono, M.D., worked from member feedback to establish a clear format and to make them very accessible.
Dr. Bono told OTW, “I think that the Coverage Documents will not only be helpful on the reimbursement side of things for spine surgeons but also act somewhat as an decision-making algorithm. They are all designed to have qualifying criteria, when appropriate, and a discussion of the rationale of treatment recommendations based on the best available data. As such, they may be helpful outside of the U.S. as well, independent of their use in the U.S. in maintaining insurance coverage of spine procedures.”
“The reason we made the Coverage Documents free to all payors is that this we wanted to remove any barrier that would keep an insurance company from incorporating our recommendations into their own policies. Charging an insurance company would have been such a barrier.”
“As for the change to make individual policies available, we were presented with multiple requests for it. There seemed to be a growing interest, if not need, by patients, companies, and other parties in obtaining a single Coverage Document. The NASS leadership felt we should try to accommodate such requests. Through the efforts of our IT team, this has become a reality.”
Asked about any points that were particularly difficult to work out, Dr. Bono noted, “The main challenge was technical. Previously, the Coverage E-book was only available in its entirety. The NASS IT team had to perform some ‘technological magic’ and devise a way for individual access and purchase.”
As for member feedback Dr. Bono commented to OTW, “The feedback in general from members has been that the Coverage Documents have become one of the most important services that NASS provides. It is clear that the NASS recommendations are already making their way into existing insurance policies. In situations in which insurance coverage is overly restrictive and does not represent best practices, NASS members have the Coverage Documents available to them to use in appeals of coverage denials.”
“The main message is ‘Use Them!’ A lot of effort has gone into to developing NASS’ Coverage Recommendations. Now with individual chapter access, they should be even more user friendly.”
