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

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…

Conrgress is working on an unusual solution to the yearly Medicare update. The SGR formula mandates a fee decresase, projected to be about 10%. In past years, Congress has overidden the fee reduction with a modest increase. Of course, since the sustainable growth reate formula is never changed, the chasm gorws every year. This year…

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

The Medicare Anti-Markup provisions for diagnostic tests, which will be effective as of January 1, 2008, are intended to prevent physicians or other medical suppliers from purchasing either the professional component (PC) or technical component (TC) of any diagnostic test (excluding clinical laboratory tests subject to separate restrictions) and profiting or marking up the acquisition cost by billing globally in accordance with the fee schedule.Continue Reading The New Medicare Anti-Markup Diagnostistic Test Results

The 2008 Medicare Physician Fee Schedule (MPFS) Final Rule, effective for services on or after January 1, 2008, is on display in the Federal Register and will be published on November 27, 2007. The rule identifies 119 measures CMS has selected for eligible professionals to use to report quality-of-care information under the 2008 PQRI. The…

HIGHMARK  ANNOUNCES AMBULATORY SURGERY  CENTER

ACCREDITATION REQUIREMENTS

In the October 2007 PRN, Highmark announced that, as of January 2008, it will require freestanding ambulatory surgery centers (ASC) to be accredited by one of three accrediting bodies, i.e., the Joint Commission, the Accreditation Association for Ambulatory Healthcare ("AAAHC"), or the American Association for Accreditation of Ambulatory…