Physicians had hoped for budget neutrality in the Deficit Reduction Act of 2005, i.e., the “zero update,” expecting the 4.4% decrease implemented by the current Medicare Sustainable Growth Rate rules to be eliminated. The general reimbursement reduction mandated for 2006 was eliminated by DRA 2005, but DRA 2005 requires that the cost of the physician reimbursement increases be offset by future reductions, meaning that DRA 2005 is simply postponing these reimbursement decreases until future years.
Continue Reading Deficit Reduction Act — U.S. House Of Representatives Approves But Medicare Physician Increases Limited
Medicare & Reimbursement
CMS Revises Physician Voluntary Reporting Program (PVRP)
By Michael Cassidy on
Posted in Medicare & Reimbursement
On December 23, 2005, CMS implemented a streamlined PVRP by reducing the number of quality indicators to be reported using G-Code indicators from the original 36 to a “core set” of 16 special quality indicators. The revision was described in a new MedLearn Matters Release (MM 4183) and was implemented as of January 3, 2006.
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AUTOMATIC 4.4% MEDICARE REDUCTION EFFECTIVE JANUARY 1, 2006
By Michael Cassidy on
Posted in Medicare & Reimbursement
AUTOMATIC 4.4% MEDICARE REDUCTION EFFECTIVE JANUARY 1, 2006; CMS ADVISES DELAYED SUBMISSION TO EXPEDITE PLANNED “ZERO UPDATE”
CMS officials suggested that physicians intentionally delay submitting claims to await passage of the “zero update” feature of the proposed Deficit Reduction Act of 2005.
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CMS Issues P4P Demo Project Results
By Michael Cassidy on
Posted in Medicare & Reimbursement
The centers for Medicaid and Medicaid Services (CMS) reported today that quality of care has improved significantly in hospitals participating in the premier hospital quality incentive demonstration project, a groundbreaking Medicare pay for performance demonstration project. The press release was posted on the CMS website on
November 14, 2005.
Pay For Performance (P4P)
By Michael Cassidy on
Posted in Medicare & Reimbursement
P4P is the newest healthcare reform theory. Many believe the theory developed wide-spread acceptance following the landmark report, To Err is Human, published by the Institute of Medicine (IOM) in 2000, followed by the IOM report, Crossing the Quality Chasm: A New Health System For the Twenty-First Century, issued in 2001. There is almost unanimous agreement that P4P, if implemented correctly, has great potential to improve patient care. The basic premise is to (1) define quality by some measurable standard, (2) provide reimbursement incentives which compensate improved quality and (3) assess performance and pay accordingly.
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Highmark Announces Policy Restricting Concierge Medical Practices
By Michael Cassidy on
Posted in Medicare & Reimbursement
In the December 2004 PRN, Highmark stated that concierge medical practices are “not compatible” with its network requirements. Highmark stated that Blue Cross Blue Shield will initiate termination of impacted provider contracts or a without cause basis upon learning of conversion to concierge practice models.
“Incident To” Rules Effective July 25, 2005
By Michael Cassidy on
Posted in Medicare & Reimbursement
As of Monday, July 25, Medicare will only pay for physical therapy services provided in physician offices “incident to” the physician’s services if the physical therapy services are provided by “qualified personnel” as defined in a June 24 transmittal to Medicare contractors.
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Highmark Defines Concurrent Care Reimbursement Policies
By Michael Cassidy on
Posted in Medicare & Reimbursement
Highmark will pay for care by more than one physician for treatment of hospital or skilled nursing facility in patients when the physicians are treating two or more separate conditions or the severity of the single condition requires the services of two or more physicians. The medical records should:
– Document the primary physician’s request for the consult(s)
– Document the seriousness of the medical condition
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