News

Highlights of H.B. 6331, Medicare Improvements for Patients and Providers Act of 2008 as Passed by the Senate on July 9, 2008 " Provides 18-month Medicare physician payment fix, stopping the 10.6% Medicare physician payment cut on July 1, 2008, and the 5.4% cut on Jan. 1, 2009, extending the June 2008 rates through Dec. 31, 2008, and providing an additional 1.1% update for 2009.

" According to CBO cost estimates, a 1% update for 2009 funded in a way that produces no budgetary effects after 2009 would lead to a 21% cut in January 2010. Establishes a Medicare Improvement Fund and deposits $19.9 billion for use in 2014-17.

" Requires that budget neutrality adjustments for 2007 and 2008 relative value changes be applied to the conversion factor, instead of work relative values, effective in 2009.

" Extends work GPCI floor through 2009 and provides a 1.5 work GPCI for Alaska starting in 2009.

" Extends PQRI reporting for 2 years and provides a 2% bonus payment for reporting.

" Adds new funding and expanded authority for the Medical Home Demonstration Project.

" Provides a 5% pay increase for certain mental health services from July 1, 2008, through Dec. 1, 2009.

" Provides teaching anesthesiologists 100% payment for two concurrent cases starting in 2010.

" Extends the exceptions process for therapy caps through December 31, 2009.

" Allows independent laboratories to bill for pathology services furnished to hospital patients through 2009.

" Permanently extends the accommodation for physicians ordered to active duty in the armed services so that they can engage in substitute billing arrangements for more than 60 days.

" Delays Medicare durable medical equipment (DMEPOS) competitive bidding program for 18 months (offset with reduced DMEPOS payments). Allows HHS to permanently exempt physician suppliers of DMEPOS from DME accreditation.

" Increases asset limits for beneficiaries to qualify for Part D low-income subsidy.

" Expands coverage of Medicare preventive services, including the Welcome to Medicare visit.

" Provides Medicare coverage of cardiac and pulmonary rehabilitation services.

" Phases in a reduction in copays for mental health to the same level as other outpatient services (20%).

" Allows Part D coverage of benzodiazepines and barbiturates.

" Provides the same standard for off-label drug coverage under Part D as under Part B.

" Phases out double payment to MA plans for indirect medical education.

" Establishes prohibited federal marketing practices and confers states with authority to regulate MA and Part D marketing abuses. Prohibitions include no marketing activities in physician offices.

" Eliminates the ability of MA private fee- for-service (PFFS) plans to deem physicians where there are two or more MA HMO or PPO plans in an area, beginning in 2011.

" Provides a 2% bonus in 2009 and 2010 for e-prescribing by eligible physicians, reduced to 1% in 2011 and 2012 and 0.5% in 2013. If eligible physicians do not e-prescribe, imposes penalties of -1% in 2012, -1.5% in 2013, and -2% in 2014 and beyond. Provides hardship exceptions.

" Requires physicians and other suppliers that furnish advanced diagnostic imaging services (MRI, CT, and nuclear medicine/PET) to meet Medicare accreditation standards by January 1, 2012.

" Extends the Federal Payment Levy program to Medicare providers. This is an IRS program to collect revenues from federal contractors who fail to pay their taxes.

Update on Medicare Claims Processing

By statute, Medicare electronic physician claims may not be paid sooner than 14 days after the date of submission, nor can clean electronic claims be paid any later than 30 days after the date they are submitted. (Paper claims are paid after the 29th day.)

The Secretary of Health and Human Services announced on June 27 that the Centers for Medicare and Medicaid Services (CMS) had instructed its carriers not to process any physician or non-physician practitioner claims for the first 10 business days of July. According to HHS, this hold on claims meant that no payments reflecting the 10.6 percent pay reduction that took effect on July 1 would occur before July 15, at the earliest.

CMS also indicated that it did not have the capacity to hold more than 10 days of claims. The hold was a rolling 10-day hold; therefore, with claims submitted the first days of the hold being processed on the 11th day of the hold, claims submitted the second day being processed on the 12th day, etc. The first payments on claims that physicians would have received reflecting the 10.6 percent reduction would occur on or after July 15.

Now that Congress has passed a law reversing the cuts retroactive to July 1st, Medicare carriers are switching their systems back to the June 2008 rates (and increasing rates for certain mental health services). Some carriers may already have posted the new, correct rates, but others could take a week or more. CMS has stated that it will automatically reprocess any claims paid at the reduced rates and provide the balances due to physician practices that are short-hanged, most likely as a single batched check. The new law makes other important changes as well, such as reinstating the therapy caps exceptions process as of July 1st. Claims submitted with the therapy cap exception modifier will be processed as soon as the new payment rates have been activated. Claims submitted without the modifier, and rejected or denied, can be resubmitted with the modifier for reimbursement. In addition, the Durable Medical Equipment Competitive Bidding Program, which affects 10 competitive bidding areas, has been delayed. Medicare beneficiaries may use any Medicare-approved supplier for Durable Medical Equipment.

Medical Leaders Meet with Governor On Health Issues

Dr. John Foley and Phyllis Darby, Executive Director, represented New London County Medical Association at a meeting of medical leaders and Governor Rell on Tuesday, July 22, 2008 to discuss a wide range of health issues. Making his point at the session, and as part of a follow-up letter to the Governor, Dr. Foley made the following comments . . . Regarding med mal and the legislation passed three years ago, there are some that will say the situation has improved. The fact of the matter is that while rates may have stabilized, there have been no reductions. And in my opinion, the real story is in the way doctors in Connecticut have been forced to practice medicine.

We are practicing a style of defensive medicine, constantly looking over our shoulders  a manner that we are not very happy about and if you stop to think about, a manner that is not really cost-effective.

If you really want to help the physicians of Connecticut, especially those in primary care, you might act to change the environment. That will require meaningful tort reform that will allow physicians to practice in a manner in which they were trained, instead of practicing medicine forced on us by insurance companies or government edicts. Unless we do this, the ongoing supply of quality physicians, especially those in primary care, will dry up and Connecticut citizens will be the losers.

NLCMA Offers Seminar on Physicians Compliance Issues

Continuing in its effort to offer educational seminars to its members, NLCMA will hold a 4-hour lecture on September 8, 2008 at Lawrence & Memorial Hospital from 5:00 to 9:00 p.m. A deli buffet will be provided starting with registration at 4:45 p.m. The speaker is Linda Dixon, CPC, CCP, ACE S-OB/GYN, who has over 24 years experience in compliance, coding, auditing, managing a medical practice and helping physicians and their staff understand healthcare regulations.

Do you know 3-4 chronic underlying diseases constitute a 4th level of CPT? Do you know upcoding and downcoding are fraud and abuse areas of concern? Do you know renewing a medication or doing a monitoring a condition can be a 3rd level? Do you know what Dx codes can take you to a 4th level? Stop Downcoding  Get Paid for What You Do!! Use Diagnoses Codes to Support Your Work  Use Proper Modifiers.

NLCMA is dedicated to bringing, updating and providing information to physicians and/or their office staff. As part of this lecture, you will understand that Medicate is now allowing:

" Payment for a one-time only screening examination for abdominal aortic aneurysm.

" Cardiovascular screening blood tests for the purpose of early detection of cardiovascular disease in individuals without apparent signs and symptoms.

" IPPE examinations must include the EKG

" Refunds of duplicate Medicare Secondary payments must be made within sixty days of receipt or discovery.

" Medicare Provides coverage of medical nutrition therapy for beneficiaries diagnosed with diabetes and/or renal disease.

" PAP Test Screening, Pelvic Exam Screening, Mammography Screening all female Medicare Beneficiaries at high risk - PAPS V15.89 primary diagnosis.

For your convenience, a Registration Form for this seminar is enclosed with this Newsletter. For more information, call Phyllis Darby at the NLCMA Executive Office  (860) 447-9408.