CMS published the final rule containing the Medicare Physician Fee Schedule for 2009 on November 19, 2008. Included in the final rule are:
1. Confirmation of the 1.1% Physician Fee Schedule increase for 2009.
2. Designated Health Service list for 2009 for Stark/Physician Self-Referral purposes.
3. Final performance standards for Independent Diagnostic Testing …
Modern Healthcare (10/31, Lubell) reports, "Physicians will receive a 1.1 percent increase to their Medicare payments in 2009 under a final rule issued by" the Centers for Medicare and Medicaid (CMS). This "update reflects a provision included in the…
On October 6, 2008 CMS announced its intent to aggressively enhance its efforts to find and prevent waste, fraud and abuse in Medicare. In particular, CMS indicated that it intends to work directly with beneficiaries to insure that they are properly receiving the durable medical equipment and home health services for which Medicare was billed and…
In an MLN Matters announcement, a copy of which is attached at the Link below, CMS has added False Claims Act implications to reporting purchased technical components of diagnostic services. While admittedly any intentional misreporting of the purchased services would be subject to False Claims Act implications, CMS has taken the uncertainly out of this matter …
The PROMETHEUS Payment(R) Model is a new program which is designed to pay providers fairly, improve quality, enhance transparency and still be more efficient than what we have today. At www.prometheuspayment.org, you will find much information about this not-for-profit, tax exempt program which has received more than $6 million from the Robert Wood Johnson…
1. Medicare Physician Fee Schedule. The sustainable growth rate (SGR) automatic physician compensation reduction of -10.6% was retroactively replaced with a .5% increase, essentially maintaining the .5% conversion factor increase implemented for January-June 2008.
2. Incentive Payments. Extends through 2010 incentive payments for implementation of electronic prescription systems (EPS).
3. Medicare Advantage Plan. …
The CMS Medical Learning Network ("MLN") has posted an Evaluation and Management Services Guide for billing and coding. The Guide is a useful explanation of this complicated area and provides links to the 1995 and 1997 Documentation Guidelines for Evaluation and Management Services, as well as the Medicare Claims Processing Manual and the Current Procedure Terminology …
In follow up to a previous posting, the Wall Street Journal recently reported that the Medicare Recovery Audit Contractor Program has identified 1.03 billion dollars of improper payments over the past three years, about 992.7 million dollars of which were over-payments by Medicare. While the Recovery Audit Contractor Program is currently underway in six states, Medicare…
CMS is acknowledging the continued interest in Pay for Performance ("P4P") and gainsharing ideas, and is issuing a specific self-referral exception in Anti-Kickback Safe Harbor to permit these programs. P4P programs are being hereinafter referred to as incentive payments, and gainsharing programs are now being referred to as shared savings programs.
The …
New 2008 Medicare Physician Fee Schedule Payment Rates Effective for Dates of Service July 1, 2008 through December 30, 2008
The Medicare Improvements for Patients and Providers Act of 2008 was enacted on
July 15, 2008. As a result, the mid-year 2008 Medicare Physician Fee Schedule (MPFS) rate of -10.6 percent has been replaced with …
