In the Proposed Rules, the link for which was provided in the August 29, 2006 MedLaw Blog post, CMS announced proposed changes to the reassignment exceptions for purposes of Medicare billing and to the definition of “centralized building” for purposes of the ancillary services exception of Stark II.
REASSIGNMENT
CMS is basically proposing to treat…
CMS and the OIG are concerned with the potential for erroneous payments for either unjustified or medically unnecessary services in the independent diagnostic testing facilities (IDTF), which concern is initially based upon an audit performed for fiscal year 2001 by the OIG (A-03-03-00002). Therefore, in the August 22, 2006 Proposed Regulations, a link to which was…
The Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services issued the 2007 Proposed Physician Fee Schedule in the August 22, 2006 Federal Register: http://www.cms.hhs.gov/quarterlyproviderUpdates/downloads/cms1321p.pdf. In addition to the fee schedule reductions arising out of the proposed revisions to the work relative value units (RVUs) as proposed in…
Following is the text from the payment delay reminder issued by HGSAdministrators (now Highmark Medicare Services):
A brief hold will be placed on Medicare payments for all claims during the last 9 days of the Federal fiscal year (September 22 through September 30, 2006). These payment delays are mandated by Section 5203 of the Deficit…
Senator Bill Frist has launched a new healthcare Blog. MedicalMatter.org: a21st Century Discussion of Health Care Issues. According to the inaugural post, the blog is about "healthcare and the politics of healthcare", and will address issues such as electronic health records (EHR), stem cell research, health savings accounts (HSA), and many other topics.
Physician Care Plan Oversight (CPO) is paid under the Medicare Physician Fee Schedule (MPFS), and due to a provision in the Medicare Claims Processing Manual (Publication 100-04, Chapter 12, Section 180), Non-Physician Practitioners (NPPs) have been prohibited from billing for this service in a home health setting.
The current manual section (Section 180) provides that…
MEDICARE PROGRAM: 5 YEAR REVIEW OF WORK RELATIVE VALUE UNITS UNDER THE PHYSICIAN FEE SCHEDULE
On June 29, 2006, the Centers for Medicare and Medicaid Services (CMS) proposed its 5 year update to the work relative value units (RVUs) used for the physician fee schedule, linked hereto at Physician Fee Schedule. Note, this is…
On June 22, 2006, CMS announced proposed changes for the Medicare Physician Fee Schedule. The proposed changes will appear in the June 29, 2006 Federal Register. The proposed changes include a comprehensive review of the RVU work component for Evaluation and Management Codes, which is projected to increase Medicare expenditures by $4 billion, and a…
FOR HIGH VOLUME PROCEDURES
In an effort to facilitate consumer directed healthcare, CMS has begun posting the payments that Medicare will make for certain high volume procedures. At this point, the approved Medicare Payments are included in the segment of the CMS website constructed to provide consumer information. Although informative, reports of the action express…
Under Medicare Part D Regulations, employers who sponsor health plans must: (1) determine whether the plan’s prescription drug coverage is equivalent to Medicare Part D (“Creditable”); (2) send notice of the status at least to Medicare-eligible participants and dependents’ and; (3) must report the status to CMS. These reporting requirements help Medicare-eligible individuals decide whether to enroll in or to delay enrollment in Medicare Part D.
Continue Reading Better Late than Never- Health Plan Sponsors’ Obligations under Medicare Part D Regulations
