DEFICIT REDUCTION ACT OF 2005:
SUMMARY OF MEDICARE REIMBURSEMENT CHANGES
President Bush signed the Deficit Reduction Act of 2005 (DRA 2005) on February 8, 2006. DRA 2005 contained numerous budget cutting provisions impacting Medicare and Medicaid reimbursement programs. Following is a description of the most significant.
Continue Reading DEFICIT REDUCTION ACT OF 2005:
AMBULATORY SURGERY CENTER, GAIN SHARING DEMONSTRATION PROJECTS, THERAPY SERVICE, AND SPECIALTY HOSPITAL REFERRAL PROHIBITIONS
As reported last week, the House of Representatives has passed the Deficit Reduction Act of 2005 (DRA 2005), which is expected to be signed by President Bush in the very near future. When ultimately passed, we will provide a more detailed explanation of the critical issues, but the following are additional reimbursement issues impacted by DRA 2005:
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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
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.
Continue Reading CMS Revises Physician Voluntary Reporting Program (PVRP)
Credentialing Developments: U.S. Supreme Court Refuses To Review Hearing Officer Authority Ruling; Ohio Court Of Appeals Allows Discovery Of Peer Review Records Under Prior Law
Hearing Officer Authority
In California, a Medical Staff Hearing Officer terminated a Medical Staff Hearing on the grounds the physician was “repeatedly disruptive, disdainful of the Hearing Officer’s authority, and flagrantly violated the rules pertaining to discovery and documentary exhibits.” This ruling allows the ruling by a California State Court that the termination did not violate the physician’s due process rights to stand. Meleikowsky v. Tenet Healthsystem, U.S. No. 05-638.
Continue Reading Credentialing Developments
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.
Continue Reading AUTOMATIC 4.4% MEDICARE REDUCTION EFFECTIVE JANUARY 1, 2006
The Commonwealth Court of Pennsylvania ruled on December 29, 2005 that a group of policyholders, subscribers, public interest groups and the City of Philadelphia did not have standing to challenge the Pennsylvania Insurance Department’s approval of reserves and surpluses for the State’s Blues plans, i.e., Capital Blue Cross, Highmark, Blue Cross of Northeastern Pennsylvania and Independence Blue Cross.
Continue Reading Pennsylvania “Blues” Win Challenge Regarding Allowable Reserves
In Bocobo v. Radiology Consultants of South Jersey, et al, a federal district court granted summary judgment to the radiology group and hospital defendants on eleven counts including the denial of a medical staff hearing. The radiologist was employed by the radiology group and the exclusive contract between the hospital and the group provided that…
Both houses of Pennsylvania have extended the MCare abatement program for 2006. The bill now goes to Governor Rendell for signature.
Medical Staff By-Laws, and the Hospital policies enacted by the Board pursuant to those By-Laws, constitute a contract between the Hospital…
Continue Reading Medical Staff Bylaws and Policies Are Contracts But No Due Process Rights Triggered by Exclusive Contract
