CMS has established a Medicare learning network web page dedicated to Medicare fee for services advance practice nurses and physician assistants. It includes definitions, licensing requirements, enrollment procedures, reimbursement guidelines, and links to related materials. The website is accessible at the following link:
Medicare & Reimbursement
IDTF Medicare Changes for 2009
By Michael Cassidy on
Posted in Medicare & Reimbursement
Independent Diagnostic Testing Facility Developments
The 2009 Medicare Physician Fee Schedule Regulations include two provisions regarding Independent Diagnostic Testing Facilities. 42 CFR §410.33 has been supplemented with two additional subsections.
First, Section (16) states all entities that provide diagnostic imaging services to Medicare beneficiaries will be required to enroll as IDTFs regardless…
Medicare 2009 Anti-Markup Rules
By Michael Cassidy on
Posted in Long Term Care, Medicare & Reimbursement
The revised Anti-Markup Final Rules were published by CMS on November 19, 2008 in the Federal Register, as part of the Medicare 2009 Physician Fee Schedule. The entire text of the 2009 Medicare Physician Fee Schedule and the related rules, i.e. Anti-Markup, Independent Diagnostic Testing Facility, physician referral issues, etc. were posted by the Med …
2009 MEDICARE PHYSICIAN FEE SCHEDULE
By Michael Cassidy on
Posted in Medicare & Reimbursement
CMS published the final rule containing the Medicare Physician Fee Schedule for 2009 on November 19, 2008. Included in the final rule are:
1. Confirmation of the 1.1% Physician Fee Schedule increase for 2009.
2. Designated Health Service list for 2009 for Stark/Physician Self-Referral purposes.
3. Final performance standards for Independent Diagnostic Testing …
Physicians Will Get 1.1% Medicare Increase for 2009
By Michael Cassidy on
Posted in Medicare & Reimbursement
CMS says physicians will receive a 1.1 percent Medicare pay increase starting in 2009.
Modern Healthcare (10/31, Lubell) reports, "Physicians will receive a 1.1 percent increase to their Medicare payments in 2009 under a final rule issued by" the Centers for Medicare and Medicaid (CMS). This "update reflects a provision included in the…
CMS Announces Increase Efforts to Fight Fraud, Waste and Abuse in Medicare
By Michael Cassidy on
Posted in Medicare & Reimbursement
On October 6, 2008 CMS announced its intent to aggressively enhance its efforts to find and prevent waste, fraud and abuse in Medicare. In particular, CMS indicated that it intends to work directly with beneficiaries to insure that they are properly receiving the durable medical equipment and home health services for which Medicare was billed and…
Medicare Adds False Claims Authority to Purchased Diagnostic Services
By Michael Cassidy on
Posted in Medicare & Reimbursement
In an MLN Matters announcement, a copy of which is attached at the Link below, CMS has added False Claims Act implications to reporting purchased technical components of diagnostic services. While admittedly any intentional misreporting of the purchased services would be subject to False Claims Act implications, CMS has taken the uncertainly out of this matter …
PROMETHEUS: Innovative Physician Payment Model Seeks Physician Input
By Michael Cassidy on
Posted in Medicare & Reimbursement
The PROMETHEUS Payment(R) Model is a new program which is designed to pay providers fairly, improve quality, enhance transparency and still be more efficient than what we have today. At www.prometheuspayment.org, you will find much information about this not-for-profit, tax exempt program which has received more than $6 million from the Robert Wood Johnson…
Key Points of Medicare Improvement for Patients and Providers Act of 2008 (MIPPA)
By Michael Cassidy on
Posted in Medicare & Reimbursement
1. Medicare Physician Fee Schedule. The sustainable growth rate (SGR) automatic physician compensation reduction of -10.6% was retroactively replaced with a .5% increase, essentially maintaining the .5% conversion factor increase implemented for January-June 2008.
2. Incentive Payments. Extends through 2010 incentive payments for implementation of electronic prescription systems (EPS).
3. Medicare Advantage Plan. …
CMS PROVIDES EVALUATION AND MANAGEMENT SERVICES GUIDE
By Michael Cassidy on
Posted in Medicare & Reimbursement
The CMS Medical Learning Network ("MLN") has posted an Evaluation and Management Services Guide for billing and coding. The Guide is a useful explanation of this complicated area and provides links to the 1995 and 1997 Documentation Guidelines for Evaluation and Management Services, as well as the Medicare Claims Processing Manual and the Current Procedure Terminology …