For 2009, major changes will be made to coding for cardiac device monitoring services. There will be 23 new codes for reporting the following services:

• Pacemaker interrogations and programming
• Implantable Cardioverter-Defibrillator (ICD) interrogations and programming
• In-person and remote interrogation of pacemakers and ICDs
• Transtelephonic monitoring
• Wearable defibrillator interrogation and evaluation
• Peri-procedural device evaluation and programming

The new codes will become effective January 1, 2009.

For more information, visit http://www.hrsonline.org/.

On October 30th, the Centers for Medicare & Medicaid Services (CMS) released its MPFS final rule for 2009. The new physician payment conversion factor for 2009 is $36.066, which incorporates the 1.1% payment update, even though this figure is lower than the current conversion factor of $38.0870. This is because a provision in the recently passed Medicare Improvements for Patients and Physicians Act (MIPPA) altered the way the budget neutrality (BN) adjustor works. The BN adjustor has been applied to work relative value units (RVUs), but under MIPPA, the adjustment will be applied to the entire conversion factor. Overall, 2009 payments will increase by an average of 1.1%.

The rule adds ten new procedures to the list of procedures subject to the 25% reduction of the technical component (-TC) of second and subsequent procedures done on contiguous body parts in the same imaging session.

Another key provision is the implementation of a five-year program of incentive payments for eligible professionals who are successful electronic prescribers.

The final rule with comment was published in the November 19 Federal Register. Comments on designated provisions are due by 5:00 p.m. Eastern Time on December 29. The final rule will be implemented January 1, 2009.

For more information about the final MPFS, please visit http://www.access.gpo.gov/su_docs/fedreg/a081119c.html.

On October 30, 2008, the Centers for Medicare and Medicaid Services (CMS) issued the 2009 final hospital outpatient prospective payment system (OPPS)/Ambulatory Surgical Center (ASC) rule on their website. The final rule provides a 3.6% annual inflation update for hospital outpatient departments (HOPDs) and adopts changes to payment policies for HOPDs and ASCs beginning on January 1, 2009. The law set the ASC update for CY 2009 at 0 percent. The final rule with comment was published in the November 18 Federal Register. Comments on designated provisions are due by 5:00 p.m. Eastern Time on December 29, 2008. The rule will be implemented on January 1, 2009.

Key provisions of the final rule include:

Device-intensive procedures
52 new device-intensive procedures from the list of ASC covered surgical procedures will be added and will be subject to the full and partial credit payment reductions for CY 2009.

Payment for drugs and pharmacy overhead in the hospital outpatient setting
For 2009, payable drugs and biologicals will be paid at the average sales price plus 4 percent when the average price is above $60.

Composite APCs for multiple imaging Services
CMS will establish five imaging composite Ambulatory Payment Categories (APCs) based on the families of codes used in the Medicare Physician Fee Schedule (MPFS) for the multiple imaging procedure payment reduction policy under that system. These composite APCs, which would provide a single APC payment when two or more imaging procedures using the same imaging modality were provided in a single session, would encourage imaging efficiencies under the OPPS. The final new imaging composite APCs include:

• Ultrasound
• Computed tomography (CT) and computed tomographic angiography (CTA) without contrast;
• CT and CTA with contrast;
• Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) without contrast; and
• MRI and MRA with contrast.

CMS will not make any policy changes regarding ASC payment for partial or full device credits. Current ASC policies for ASC payments for partial or full device credit are the same as OPPS policies.

For more information on the CY 2009 final rule with comment period for the OPPS and ASC payment system, please visit: http://www.access.gpo.gov/su_docs/fedreg/a081118c.html.

The Centers for Medicare & Medicaid Services (CMS) has announced it will be postponing all activity involving the four permanent Medicare recovery audit contractors (RAC) because of a “RAC protest and stay of performance.” All outreach sessions in the first round of RAC states, which were to begin in November, have been delayed until further notice. CMS said that, in the meantime, it continues to prepare for the permanent nationwide RAC program and indicated that it will post further detail about the reasons behind the postponement on its web site.

For more information, go to http://www.cms.hhs.gov/RAC/.

The Centers for Medicare & Medicaid Services (CMS) has released an interim final rule aimed at reducing financial conflicts of interest for agents and brokers enrolling beneficiaries in Medicare Advantage and prescription drug plans. Effective immediately, the rule modifies a September 18 interim final rule to specify that all compensation paid to agents and brokers must reflect fair-market value based on past commissions and adjusted for inflation for similar products in the same geographic area. Among other changes, the compensation for renewing a beneficiary’s enrollment must equal half of the compensation paid for their initial enrollment.

The rule was published in the November 14 Federal Register, with comments accepted through December 15 and is available at http://www.access.gpo.gov/su_docs/fedreg/a081114c.html.

The Centers for Medicare & Medicaid Services (CMS) has announced that beginning in 2010 only people with certain medical conditions will be eligible for Medicare Advantage special needs plans for chronic conditions. The 15 conditions were identified by an advisory panel convened by CMS, as directed by the 2008 Medicare Improvements for Patients and Providers Act (MIPPA). The conditions are: chronic alcohol and other drug dependence; certain autoimmune disorders; cancer (excluding pre-cancer conditions); certain cardiovascular disorders; chronic heart failure; dementia; diabetes mellitus; end-stage liver disease; end-stage renal disease requiring dialysis (all modes of dialysis); certain severe hematologic disorders; HIV/AIDS; certain chronic lung disorders; certain chronic and disabling mental health conditions; certain neurologic disorders; and stroke. The panel identified the 15 conditions as being medically complex, substantially disabling or life threatening, having a high risk of hospitalization or other adverse outcomes and requiring a specialized delivery system across domains of care.

The announcement can be found by going to http://www.cms.hhs.gov/.

The Centers for Disease Control and Prevention (CDC) has updated its guidelines for cleaning, disinfecting and sterilizing medical devices and the health care environment. The updated guidelines include topics such as inactivating antibiotic-resistant bacteria and disinfecting complex medical instruments such as endoscopes. The guidelines were last updated in 1985.

The guidelines can be found at http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Disinfection_Nov_2008.pdf.