Reprinted from Physician News Briefs
By Ceci Connolly and Michael D. Shear
Washington Post Staff Writer
Wednesday, July 15, 2009; 2:42 PM
After a key Senate committee pushed forward with an overhaul of the nation’s health care system, President Obama today sought to reassure Americans satisfied with their current health insurance that the plans passed…
In the proposed changes to the Hospital Outpatient Prospective Payment System, CMS is proposing to change the physician supervision requirements applicable to hospital outpatient services described in the 2009 Hospital Outpatient Prospective Payment System (OPPS) final rule. In the proposed rulemaking release, issued July 1, 2009, CMS indicates that physician supervision requirements requiring "direct supervision"…
This proposed rule would update the revised Medicare Ambulatory Surgical Center (ASC) Payment System to implement applicable statutory requirements and changes arising from CMS’s continued experience with administrating that system. The proposed rule sets forth applicable relative payment weights and amounts for services furnished in ASCs, the specific HCPCS codes to which these proposed changes would…
The Centers for Medicare and Medicaid services released its proposed Medicare Physician Fee Schedule for 2010. The press release and the entire 1,200 fee schedule are attached. CMS is projecting a 21.5% physician fee schedule decrease based upon the application of the sustainable growth rate (SGR) formula. Of course, Congress has intervened in each of the last five…
President Obama signed the Fraud Enforcement and Recovery Act of 2009 on May 28, 2009, which is the effective date of the Act.
I am attaching a compared version identifying all the changes, but I would like to direct your attention to what I believe is the most significant change impacting typical healthcare providers.
Retentions …
The Centers for Medicare & Medicaid Services (CMS) has become aware of a scam where perpetrators are sending faxes to physician offices posing as the Medicare carrier or Medicare Administrative Contractor (MAC). The fax instructs physician staff to respond to a questionnaire to provide an account information update within 48 hours in order to prevent…
Highmark Medicare Services will be hosting a teleconference on May 15, 2009 at 12:00 p.m. Eastern to discuss the billing of time units for physical and occupational therapy services. The teleconference may reference issues such as CMS Online Manual, Pub. 100-2, Chapter 15, Sections 220 and 230; Change Request CR6321; Frequently Asked Questions…
In a potentially striking blow to the Pennsylvania Medicaid (Medical Assistance)Third Party Liability (“TPL”) collection practices, the Honorable Joy Flowers Conti, Judge for the United States District Court for the Western District of Pennsylvania, issued a Memorandum Opinion dated March 25, 2009 in the Tristani v. Richman et al. proposed class action. PAWD Civil Action…
Highmark has issued four new local coverage determinations, as follows:
The following is the link of the full text of those LCDs: http://www.highmarkmedicareservices.com/policy/draft-status.html
The 2009 Medicare Physician Fee Schedule made some changes regarding physician enrollment. The most significant change is the elimination of retroactive billing. Prior to the 2009 changes, Medicare permitted retroactive billing for up to 27 months following the effective date of a physician’s Medicare enrollment, to allow physicians to bill for services that they provided while the…
