December 2007

CMS has presented a New Years gift. The effective date of the Anti-Markup rules with respect to the professional component of diagnostic tests will be delayed until January 1, 2009. Following is the text of the CMS press release. The anti-markup rules for the technical component will not be delayed because they existed by statute prior to the latest proposed regulations.

CMS today issued a final rule delaying until January 1, 2009, the applicability of the anti?markup provisions in §414.50, as revised at 72 FR 66222, except with respect to: (1) the technical component of a purchased diagnostic test and (2) any anatomic pathology diagnostic testing services furnished in space that (i) is utilized by a physician group practice as a "centralized building" (as defined at §411.351 of this chapter) for purposes of complying with the physician self-referral rules and (ii) does not qualify as a "same building" under §411.355(b)(2)(i). This final rule is available for public inspection at the Office of the Federal Register as of 1:17 p.m., today, December 28, 2007, and is effective January 1, 2008. The final rule will be published in the January 3, 2008 Federal Register.

The text below is that of the CMS-approved document that was submitted to the Office of the Federal Register (OFR) for publication and placed on public display on December 28, 2007. The document is pending publication in the Federal Register. This document may vary slightly from the published document if minor editorial changes have been made during the OFR review process. The document published in the Federal Register is the official CMS-approved document.

Continue Reading CMS New Years Present: Anti-Markup Rules Effective Date Delayed Until January 1, 2009

On November 1, 2007, the Centers for Medicare and Medicaid Services ("CMS") released its final Medicare Physician Fee Schedule Rule for calendar year 2008. In addition to announcing CMS’ payment rates for 2008, the final rule includes a new definition of physical therapist assistant and sets forth certain personnel standards for the provision of physical therapy services. Continue Reading MEDICARE PROVIDES NEW DEFINITION OF PHYSICAL THERAPIST ASSISTANT

The California Supreme Court has agreed to hear the appeal of Mileikowsky vs. West Hills Hospital and Medical Center. The question to be heard on appeal is:

“Does the presiding officer in a medical review proceeding have the authority to terminate the hearing as a sanction for a party’s failure to cooperate in discovery, or…

 

U.S. House approves Medicare physician reimbursement, SCHIP extension bill.

In continuing coverage from yesterday’s briefing, Bloomberg (12/20, Goldstein, Johnston) reports that a "scheduled cut in Medicare payments to doctors will be postponed," and the State Children’s Health Insurance Program (SCHIP) "will be extended at its current enrollment under legislation the U.S. House sent to…

A.        Refinement of Work Relative Value Units.

            Since the physician fee schedule is first established in 1992, it has been composed of three categories of relative value units, i.e., work, malpractice expense, and overhead. Each of these units is assigned a value and the sum of those units is multiplied by the dollar conversion factor to establish the Medicare reimbursement for each particular CPT code. The system includes a process for refining the work relative value units, i.e., a re-evaluation of the value of the work units assigned to each CPT code. CMS uses a standard five year review cycle based upon input by the AMA/Specialty Society Relative Scale Update Committee (RUC). For 2008, CMS has revised the work units for comprehensive hearing tests (92557), visual audiometry (92579), doppler color flow (93325), and 14 home visit codes (99336 through 99350). The values, which are contained in Table 14 of the proposed physician fee schedule, is attached below at the link entitled Table 14: Work RVU Revisions.

www.medlawblog.com/Table 14 Work RVU Revisions(1).pdfContinue Reading 2008 MEDICARE RVU REFINEMENTS

The 2008 Medicare Physician Fee Schedule also includes revised performance standards for Independent Diagnostic Testing Facilities (IDTFs). The revisions are promulgated via 42 CFR § 410.33. The link below is the text of the regulations with the new provisions "boxed" for easy identification. Following is a description of these new IDTF performance standards beginning January 1, 2008:   Continue Reading New Medicare IDTF Performance Standards Effective January 1, 2008

Pennsylvania law states that medical providers and hospitals must provide copies of patients’ medical records upon request, but may charge a fee for copying and producing the medical records. That fee is addressed annually. 

The link below is the announcement by the Pennsylvania Department of Health, entitled “Amendments to Charges for Medical Records,” which was published…

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