On Thursday, March 28, CMS issued a new MLN Connects article, which included updates for ambulatory surgery center payments. A link is attached below: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM11232.pdf … Continue Reading
As part of the 2019 Medicare annual inpatient prospective payment system (PPS) fee schedule update, CMS has added a “rule” requiring hospitals to publish a list of standard charges beginning January 2019. CMS explained this initiative under the “Transparency” and “Request for Information” topics in the following link: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2019-medicare-hospital-inpatient-prospective-payment-system-ipps-and-long-term-acute-0 CMS subsequently issued two sets of … Continue Reading
The 2019 proposed Medicare Fee Schedule was published on July 27, 2018 by CMS at https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-14985.pdf. Pages 61 through 91 of the Executive Summary are devoted to: Modernizing Medicare Physician Payment by Recognizing Communication Technology-Based Services. Click here to read: Modernizing Medicare Physician Payment by Recognizing Communication Technology-Based Services. This subsection is devoted to explaining both … Continue Reading
Just as a point of providing information, please note that CMS has revised its Medicare Learning Network (MLN) booklet for telehealth services. The February 2018 edition is included in this link. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/TelehealthSrvcsfctsht.pdf The 2019 proposed Medicare Physician Fee Schedule Rule also seeks comments on proposed expansion of telehealth services. That will be the subject of … Continue Reading
Telehealth has apparently reached the tipping point in its significance to the Medicare budget, because OIG has now announced that it will “review Medicare claims for telehealth services provided at distant sites that do not have corresponding claims from originating sites to determine whether those services met Medicare requirements.” The expected issue date of the … Continue Reading
In Robie v. Price, Dr. Robie successfully obtained a temporary restraining order prohibiting CMS from terminating his Medicare billing privileges prior to the exhaustion of his administrative remedies by the U.S. District Court for the Sothern District of West Virginia. As most realize, exhaustion of administrative remedies is usually a prerequisite to further litigation for … Continue Reading
The 2017 Medicare Physician Fee Schedule finalizes the CMS changes for Telehealth reimbursement and coverage for 2017. The CMS fee schedule document also provides a comprehensive explanation of Medicare Telehealth reimbursement and coverage. I have excerpted those 35 pages and linked them as a PDF to this post: Medicare Telehealth Services. The essential takeaways are as … Continue Reading
Mike was published in this month’s Allegheny County Medical Society Bulletin regarding the Medicare reform. You can find the article here.… Continue Reading
HHS is gearing up to design and implement a revised Medicare payment system. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) has designated a merit based incentive payment system (MIPS) as a goal. CMS is tasked to design a value based payment system based upon quality, resource use, clinical practice improvement, and meaningful … Continue Reading
The ink was barely dry on the Medicare Physician Sustainable Growth Rate (SGR) fix, and it has already been changed. One component of the SGR fix, which was just passed in April of this year, was freezing Medicare physician payments from 2019 through 2025, and then allowing a .75% increase for physicians participating in alternative … Continue Reading
The Internal Revenue Code was amended in April 2015 as part of the Medicare Access and CHIP Reauthorization Act of 2015 to increase allowable IRS levies against federal payments, such as Medicare receivables, from 30% to 100% effective October 16, 2015. CMS has issued MLM Matters – MLM number MM9285, to explain these changes. … Continue Reading
CMS issued a special edition MLN Matters meant to be effective August 1, 2015. The guidance reflects CMS instructions to Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) regarding the scope of review for redeterminations and reconsiderations of certain claims. CMS acknowledges its concern that MACs and QICs were using their discretion to conduct … Continue Reading
By now, everyone knows ICD-10 coding starts October 1, 2015. Starting October 1, 2015, Medicare claims with dates of service after October 1, 2015 will only be accepted if they contain a valid ICD-10 code. The Medicare claims system will be programmed not to accept ICT-9 codes after September 30, 2015. However, Medicare announced in … Continue Reading
There are two interesting items in telehealth news. Iowa Supreme Court Rejects Ban on Telemedicine Abortions An Iowa Board of Medicine rule requires the presence of a physician when abortion inducing drugs are provided. Planned Parenthood sued claiming the requirement of physician presence was unconstitutional on the basis that it discriminated against women, due to … Continue Reading
Medicare Regulations allows CRNA’s to administer anesthesia without physician supervision if the state governor opts out of the regular physician supervision requirement. Governor Ritter of Colorado opted out in 2010, and his action was challenged by the Colorado Medical Society and the Colorado Society of Anesthesiologists. That challenge was dismissed by Colorado trial courts, which … Continue Reading
The Centers for Medicare and Medicaid Services (CMS) released a proposed rule intended to make ACOs and Medicare Shared Savings Plans more practical and attractive to potential providers. The proposed rule was released on December 1, 2014, along with a CMS Fact Sheet. Longer Lead Time to Develop In order to provide more development time, … Continue Reading
On July 21, 2014, I posted the proposed Medicare Physician Fee Schedule, and described the intent by CMS to eliminate global surgery. On November 13, 2014, CMS issued the final 2015 Medicare Physician Fee Schedule, and CMS incorporated the changes regarding global surgery. Global Surgery There are three primary categories of global surgery packages that … Continue Reading
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
Perhaps not coincidentally, immediately following the release of the Questionable Laboratory Payments Special Fraud Alert by the OIG, posted yesterday on the Med Law Blog, the OIG has followed up with Audit Report OIG – 03-11-00730: Questionable Billing for Medicare Part B Clinical Laboratory Services. Below are two quoted paragraphs from the executive summary stating … Continue Reading
Practical considerations to protect against being ‘out of network’ The disengagement of Highmark and UPMC is looming on the horizon; most of the hospital participation agreements between these two competing healthcare systems end on December 31, 2014. There are some hospital agreements that continue, such as those at Children’s and Magee, but the focus of … Continue Reading
The 2014 OIG Work Plan includes the following: Policies and Practices. We will determine the impact of subordinate facilities in hospitals billing Medicare as being hospital based (provider based) and the extent to which such facilities meet CMS’s criteria. Context—Provider-based status allows a subordinate facility to bill as part of the main provider. Provider-based status … Continue Reading
On Friday, Congressional lawmakers approved an extension to the Middle Class Tax Relief and Job Creation Act of 2012,1 which contains a "doc fix" preventing a 27.4% cut in Medicare physician payments that was set to begin on March 1, 2012.… Continue Reading
Medicare pay cut averted; Congress OKs two-month patch Physicians got a brief reprieve from a 27 percent Medicare pay cut Friday when the U.S. House of Representatives reached agreement with the Senate on a two-month extension of important policies that expire on Jan. 1. The U.S. Senate last week voted to extend current Medicare … Continue Reading
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
