CMS has proposed new Stark regulations as part of the hospital in-patient perspective payment system rules for Fiscal Year 2009. 

On April 14, 2008, CMS proposed new IPPS rules which contain proposed Stark regulations with respect to alternative solutions for the "stand in the shoes" provisions which were first proposed in the Stark Phase III…

Pittsburgh MSA Included in DMEPOS Medicare Competitive Bidding Program

Medicare will begin implementation of a Competitive Bidding Program for DMEPOS effective July 1, 2008. This program will affect patients in ten competitive bidding areas (CBAs) that align with the ten metropolitan statistical areas (MSAs) selected for the first phase of this program and includes ten product…

Highmark Medicare Local Coverage Determinations (LCDs)

Highmark Medicare Services has published the initial draft set of LCDs as part of its plans to fulfill CMS requirements to consolidate ICEs by July 1, 2008. Highmark’s instructions for submitting comments for the proposed Local Coverage Determinations (LCDs) and the proposed LCDs are included in the attached link. The following…

CMS has decided to make no change to Section 220.1 of the existing National Coverage Determination Manual titled “Computed Tomography” (PUB 100-3, 220.1). The link to the CMS announcement is:

https://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=206

The summary of the decision is as follows:

Conclusions

In summary, there is uncertainty regarding any potential health benefits or patient management alterations from including coronary CTA in the diagnostic workup of patients who may have CAD. No adequately powered study has established Continue Reading CMS DECISION MEMO FOR COMPUTED TOMOGRAPHIC ANGIOGRAPHY (HEART CT)

Medicare recently announced that it will be increasing the frequency of its audits under the Medicare Recovery Audit Program in the near future. Under the Recovery Audit Program, Medicare contracts with auditors who review the records of health care providers to determine if Medicare was incorrectly billed for services and if so, to determine the amounts…

The Medicare Appeals Process: Five Levels to Protect Providers, Physicians and Other Suppliers brochure has been updated and is now available to order print copies or as a downloadable PDF file. To view the PDF file, go to http://www.cms.hhs.gov/MLNProducts/downloads/MedicareAppealsProcess.pdf or to order hard copies, please visit the MLN Product Ordering Page at http://cms.meridianksi.com/kc/main/kc_frame.asp?kc_ident=kc0001&loc=5 on the…

CMS PUBLISHES CORRECTED 2008
AMBULATORYSURGERYCENTER FEE SCHEDULE

On February 22, 2008, CMS published corrections to the 2008 payment rates for ambulatory surgery centers. Following is the link to the corrected final rule.

http://a257.g.akamaitech.net/7/257/2422/01jan20081800/edocket.access.gpo.gov/2008/pdf/08-671.pdf

SIMPLE CMS EXPLANATION OF MEDICARE PHYSICIAN FEE SCHEDULE

CMS issued a relatively simple explanation of the Medicare Physician Fee Schedule on February 19, 2008. The release is entitled The Revised Medicare Physician Fee Schedule Fact Sheet for January 2008. It explains the following:

1.     the work, practice expense, and malpractice expense components of the RVU formula;…