Tag Archives: Medicare & Reimbursement

Face-to-Face Medicare Reimbursement Requirements for Home Health Certification

CMS has announced its concern regarding the level of compliance for documenting the face-to-face elements necessary for home health care certification. Attached is an educational piece published by Novitas Solutions on its Part B website. It lists the qualification criteria for home health benefits: Be confined to a home; Under the care of a physician; … Continue Reading

CMS Proposes 2014 Medicare Physician Fee Schedule; SGR Reduction Projected @ 24.4%

CMS has issued the poroposed Medicare Physician Fee Schedule. Without Congressional intervention, the SGR will mandate a 24.4% decrease. CMS sent its calcuations to the Medare Payment Advisory Commission.   http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SustainableGRatesConFact/Downloads/SGR2013-Final-Signed.pdf CMS has also issued a Fact Sheet Summary:   http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-Sheets/2013-Fact-Sheets-Items/2013-07-08.html?DLPage=1&DLSort=0&DLSortDir=descending… Continue Reading

DME Face-to-Face Delayed Until October 1, 2013

Additional Time to Establish Protocols for Newly Required Face-to-Face Encounters for DME Due to concerns that some providers and suppliers may need additional time to establish operational protocols necessary to comply with face-to-face encounter requirements mandated by the Affordable Care Act (ACA) for certain items of Durable Medical Equipment (DME), CMS will start actively enforcing … Continue Reading

National Commission on Payment Reform Recommends 5 Year Transition Model

The Society of General Internal Medicine convened the National Commission on Payment Reform to formulate a recommendation for healthcare payment reform. This Commission released its Report in March 2013. Although we have attached the report, here are the 12 fundamental recommendations. 1.         Over time, payers should largely eliminate stand-alone fee-for-service payment to medical practices because of its … Continue Reading

CMS Implements 0% Medicare Payment Update: Hold Claims for 10 Day

The American Taxpayer Relief Act of 2012 includes the Physician Update Fix, which essentially provides a 0% Medicare change for 2013. The Centers for Medicare & Medicaid Services (CMS) is currently revising the 2013 Medicare Physician Fee Schedule (MPFS) to reflect the new law’s requirements as well as technical corrections identified since publication of the final … Continue Reading

OIG Approves Per Diem Call Pay

OIG Advisory Opinion No. 12-15 has approved an existing arrangement under which a hospital pays physicians a per diem fee for providing on call ER coverage. Under the arrangement, the hospital pays per diem fees to 130 specialty physicians on staff who provide on-call services, including: ·         telephone consultations; ·         in-person consultations, as well as … Continue Reading

2013 Medicare Physician Fee Schedule

The Centers for Medicare & Medicaid Services (CMS) finalized the Medicare physician fee schedule for 2013. Unless Congress intervenes, the rule implements a 26.5 percent reduction in Medicare physician payments in 2013 based on the sustainable growth rate (SGR) formula. MGMA will continue its steadfast advocacy efforts to repeal the flawed SGR formula, and we … Continue Reading


CMS issued the proposed 2013 Medicare Physician Fee Schedule on July 30, 2012. The complete document package of approximately 700 pages is available on both the CMS website and at www.medlawblog.com. For this article, I will not summarize all 700 pages, but I would like to hit three of the most significant issues: 1.   27% proposed … Continue Reading

CRNA – CMS Developments

  I thought you might be interested in linking to or writing about a recent blog post by Christine Zambricki, a top official with the American Association of Nurse Anesthetists. The post originally appeared in ADVANCE for Nurses Protecting Access to CRNAs Relieves Patient Pain By Christine Zambricki, CRNA, MA, FAAN In less than two weeks, … Continue Reading

Colorado State Court Rules CRNAs May Practice Without Physician Supervision

In Colorado Medical Society v. Hickenlooper, a Colorado appeals court ruled the state of Colorado may op-out of the CMS rules requiring physician supervision of CRNAs in hospitals, ambulatory surgery centers, and critical access hospitals.  The case is actually about the Medicare regulations for hospital participation, but it is based upon the concept of private … Continue Reading

Significant Issues in the 2013Medicare Physician Fee Schedule

The 2013 Medicare Physician Fee Schedule was posted by CMS today. 27% SGR Reduction The most significant issue, of course, will be the proposed 27% Medicare physician fee schedule reduction which will be statutorily imposed because of the sustainable growth rate formula. I am sure everybody is familiar with the annual debacle over the last decade … Continue Reading

Advance Payment ACO Model

For participants in the Medicare Shared Savings Program, physician-based and rural providers who have come together voluntarily to give coordinated high quality care to the Medicare patients they serve through the Advance Payment ACO Model.  Through the Advance Payment ACO Model, selected participants will receive upfront and monthly payments, which they can use to make … Continue Reading

CMS Announces First Accountable Care Organization (ACO) Approvals

For Immediate Release: Tuesday, April 10, 2012 Contact: CMS Office of Public Affairs 202-690-6145 NEW AFFORDABLE CARE ACT PROGRAM TO IMPROVE CARE, CONTROL MEDICARE COSTS, OFF TO A STRONG START OVER 1.1 MILLION BENEFICIARIES NOW SERVED BY ACCOUNTABLE CARE ORGANIZATIONS   A new program that will help physicians, hospitals, and other health care providers work … Continue Reading

Congress Postpones SGR 27% Cut For 10 Months

  Congress approves measure averting 27 percent physician cut through 2012 A House-Senate Conference Committee tasked with identifying a compromise to avoid the pending 27.4 percent Medicare physician payment cut reached a 10-month deal that would maintain current physician payment rates through the end of the year. The measure was approved this afternoon by both … Continue Reading

HHS Announces Intent to Delay ICD-10 Compliance Date

  HHS announces intent to delay ICD-10 compliance date As part of President Obama’s commitment to reducing regulatory burden, Health and Human Services Secretary Kathleen G. Sebelius today announced that HHS will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition … Continue Reading

Are ACOs the Answer?

It may seem contradictory that Accountable Care Organizations (ACO) are championed as the new answer to manage more efficiently (i.e. improve quality and reduce costs) when the most popular form of ACOs, i.e. the Medicare Shared Savings Program, established in 2010 as a component of the Patient Protection and Accountable Care Act has yet to … Continue Reading

AMA Reports; Supercommittee Stalemate Leaves SGR 27.5 Physician Fee Schedule Decrease Intact

Supercommittee failure leaves 27 percent Medicare payment cut in place With the Joint Select Committee on Deficit Reduction failing to reach agreement on a deficit-reduction proposal, physicians still face a 27 percent cut in Medicare physician payments scheduled to take effect Jan. 1. Congress has missed an opportunity to address the nation’s fiscal problems, stabilize … Continue Reading

CMS Releases 2012 Medicare Physician Fee Schedule With 27.4% Decrease

CMS ANNOUNCES POLICY, PAYMENT RATE CHANGES FOR THE PHYSICIAN FEE SCHEDULE IN 2012 The Centers for Medicare & Medicaid Services (CMS) today issued a final rule with comment period that updates payment policies and rates for physicians and nonphysician practitioners (NPPs) for services paid under the Medicare Physician Fee Schedule (MPFS) in calendar year (CY) … Continue Reading