In continuing coverage from previous editions of Health and Life Sciences Law Daily, the New York Times (6/27, Pear) reports that physicians now "face a 10 percent cut in Medicare payments next week, following the Senate’s failure on Thursday to take up legislation that would have…
The Medicare rules for the physician fee schedule (RB-RVS) would have mandated a 10% reduction for 2008 pursuant to the sustainable growth rate (SGR) formula. Congress postponed that for the first 6 months of 2008, but he 2nd 6 months is looming. Without actionmt he postmenement ends and the automatic 10.1% reduction kicks in automatically. The House has approved another reprieve. Quick Senate action is expected. Excerpts form the WSJ report follow.
Expect the current elected officials to enact the reprieve for the next 6 months and pass this problem on to the new administration.Continue Reading House Approves Medicare Physician Fee Freeze for 2008
Highmark Blue Cross/Blue Shield announced in the April 2008 PRN that the reduction for technical component reimbursement for multiple procedures, originally intended to be effective as of July 1, 2008, will be postponed until September 1, 2008. A copy of that announcement is contained in the link below.
On May 2, 2008 CMS issued a policy update regarding services provided incident to the services of a physician/non physician practitioner. The purpose of the publication was to clarify policies related to Part B Services provided incident to the services of physicians. The publication clarifies common incident to issues such as the documentation required to authorize the…
Lawmakers concerned about Medicare’s competitive bidding program.
The Wall Street Journal (5/6, A4, Mathews) reports that on Tuesday, the U.S. House Ways and Means Health Subcommittee will hold a hearing on the Centers for Medicare and Medicaid Services’ (CMS) proposed "plan to use competitive bidding for products such as wheelchairs and walkers." Rep. Pete Stark…
On April 21, 2008 the Centers for Medicare and Medicaid Services ("CMS") released a proposed rule regarding the Fiscal Year 2009 Inpatient Rehabilitation Facility Prospective Payment System. The proposed rule discusses changes to the 75% rule and requires a freeze on inpatient rehabilitation facility rates from April 1, 2008 through September 30, 2009. The proposed rule also…
CMS has proposed new Stark regulations as part of the hospital in-patient perspective payment system rules for Fiscal Year 2009.
On April 14, 2008, CMS proposed new IPPS rules which contain proposed Stark regulations with respect to alternative solutions for the "stand in the shoes" provisions which were first proposed in the Stark Phase III…
Pittsburgh MSA Included in DMEPOS Medicare Competitive Bidding Program
Medicare will begin implementation of a Competitive Bidding Program for DMEPOS effective July 1, 2008. This program will affect patients in ten competitive bidding areas (CBAs) that align with the ten metropolitan statistical areas (MSAs) selected for the first phase of this program and includes ten product…
Highmark Medicare Local Coverage Determinations (LCDs)
Highmark Medicare Services has published the initial draft set of LCDs as part of its plans to fulfill CMS requirements to consolidate ICEs by July 1, 2008. Highmark’s instructions for submitting comments for the proposed Local Coverage Determinations (LCDs) and the proposed LCDs are included in the attached link. The following…
CMS has decided to make no change to Section 220.1 of the existing National Coverage Determination Manual titled “Computed Tomography” (PUB 100-3, 220.1). The link to the CMS announcement is:
https://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=206
The summary of the decision is as follows:
Conclusions
In summary, there is uncertainty regarding any potential health benefits or patient management alterations from including coronary CTA in the diagnostic workup of patients who may have CAD. No adequately powered study has established Continue Reading CMS DECISION MEMO FOR COMPUTED TOMOGRAPHIC ANGIOGRAPHY (HEART CT)
