1.800.456.4350 info@prgweb.com

Archive for March, 2010

PPACA Implementation Begins

Wednesday, March 24th, 2010

The Centers for Medicare & Medicaid Services (CMS) has begun to implement certain provisions of the Patient Protection and Affordable Care Act (PPACA) that was signed into law on March 23rd. The following are some of the provisions of the Act:

  • Extends a floor on geographic adjustments to the work portion of the Medicare Physician Fee Schedule (MPFS) through the end of 2010, with the effect of increasing practitioner fees in rural areas.
  • Extends the process allowing exceptions to limitations on medically necessary therapy until December 31.
  • Extends the existing outpatient “hold harmless” provision through the end of 2010, and would allow Sole Community Hospitals with more than 100 beds to also be eligible to receive this adjustment through the end of fiscal year (FY) 2010.
  • Adjusts the technical component discount on single session imaging studies on contiguous body parts from 25 percent to 50 percent.

For a section-by-section analysis of the PPACA as passed and signed into law on March 23, go to http://dpc.senate.gov/healthreformbill/healthbill63.pdf.

Expansion of ICD-9 Codes Used on Claim Forms

Monday, March 22nd, 2010

Beginning January 1, 2011, the Centers for Medicare & Medicaid Services (CMS) will be expanding the number of ICD-9 diagnosis and procedure codes it will process and accept on institutional claims. CMS currently processes only the first nine diagnosis codes and six procedure codes submitted electronically, even though the electronic format allows up to 25 ICD-9-CM diagnosis and procedure codes. In addition, the expansion will add secondary diagnosis codes and associated present on admission codes.

For more information, go to the CMS notice.

Healthcare Reform Bills Passed

Monday, March 22nd, 2010

On March 21, the U.S. House of Representatives passed Senate-passed reform bill, know as the Patient Protection and Affordable Care Act (H.R. 3590) by a vote of 219-212. It then voted 220-211 to approve the Reconciliation Act of 2010 (H.R. 4872), a package of changes to H.R. 3590. These bills would extend health coverage to 32 million uninsured people.  The Congressional Budget Office (CBO) estimates that the legislation will cost $940 billion over 10 years. The Senate is expected to vote on H.R. 4872 prior to its implementation.

The healthcare reform legislation would require most Americans to obtain health insurance, help needy individuals and families buy coverage through government-operated insurance “exchanges,” prevent private insurers from denying someone a policy based on preexisting conditions, and increase Medicaid enrollment by almost 50%.

The amendments do not alter the basic framework of the Senate healthcare reform bill, but introduce enhancements. The Reconciliation Act would:

  • Add 16 million additional Americans to the Medicaid program, compared with 15 million under the Senate plan.
  • Raise Medicaid reimbursement rates to Medicare levels for general internists, family physicians, and pediatricians in 2013 and 2014.
  • Enhance federal Medicaid funding for all states.
  • Close the “doughnut hole” in the Medicare Part D prescription drug plan.
  • Make steep cuts in payments to the Medicare Advantage plans.
  • Creates a 3.8% Medicare Part A tax on unearned income for individuals who earn more than $200,000 and $250,000 for married couples. This is in addition to a 0.9% increase in the Medicare Part A tax on earned income for these individuals and couples under the Senate bill.
  • Delay the date of an excise tax on high-cost insurance plans from 2013 to 2018.
  • Offer subsidies to individuals and families purchasing required insurance coverage.

The bills can bill can be accessed at http://www.thomas.gov

MLN Articles Published on Physician Consultation Services

Tuesday, March 16th, 2010

The Medicare Learning Network (MLN) Matters® has published a Special Edition Article (#SE1010) entitled “Questions and Answers on Reporting Physician Consultation Services”. The article is intended for physicians and non-physician practitioners (NPPs) who perform initial evaluation and management (E/M) services previously reported by Current Procedural Terminology (CPT) consultation codes for Medicare beneficiaries. The article pertains to change request (CR) 6740, which alerts providers that effective January 1, 2010 the CPT consultation codes (ranges 99241-99245 and 99251-99255) are no longer recognized for Medicare Part B payment.

The article can be accessed by going to http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE1010.pdf

In addition, another MLN Matters Article (#MM6740) entitled, “Revisions to Consultation Services Payment Policy,” is being revised to clarify language contained in the original CR and to add a reference to MLN Matters Article #SE1010.  All other information remains the same.  The revised article is available at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6740.pdf .

CMS Publishes Payment System Fact Sheets

Tuesday, March 16th, 2010

The following revised publications are now available in print format from the Centers for Medicare & Medicaid Services (CMS) Medicare Learning Network:

  • The Hospital Outpatient Prospective Payment System Fact Sheet (January 2010), which provides general information about the Hospital Outpatient Prospective Payment System, ambulatory payment classifications, and how payment rates are set.

·         The Home Health Prospective Payment System Fact Sheet (January 2010), which provides information about coverage of home health services and elements of the Home Health Prospective Payment System.

  • The Outpatient Maintenance Dialysis – End-Stage Renal Disease Fact Sheet (January 2010), which provides information about the bundledEnd-Stage Renal Disease (ESRD) Prospective Payment System for Medicare outpatient ESRD facilities that will replace the current basic case-mix adjusted composite payment system beginning January 1, 2011. It also provides information on the basic case-mix adjusted composite payment rate system, and separately billable items and services.
  • The Ambulatory Surgical Center Fee Schedule Fact Sheet (January 2010), which provides general information about the Ambulatory Surgical Center (ASC) Fee Schedule, ASC payments, and how ASC payment amounts are determined.
  • The revised Clinical Laboratory Fee Schedule Fact Sheet (January 2010), which provides general information about the Clinical Laboratory Fee Schedule, coverage of clinical laboratory services, and how payment rates are set.

For more information, visit http://www.cms.hhs.gov/MLNGenInfo/

MedPAC Recommends ASC Payment Rate Increase

Wednesday, March 10th, 2010

In its March 2010 Report, the Medicare Payment Advisory Commission (MedPAC) recommended to Congress that ambulatory surgery center (ASC) payment rates be increased by 0.6% in 2011.  ASCs would receive an inflation update in 2011 equal to the Consumer Price Update (Urban), which if calculated today would be 1.4% in the absence of congressional action.

More information is available at http://www.medpac.gov/

Proposed Rule for Health IT Certification Programs Issued

Tuesday, March 2nd, 2010

The Department of Health and Human Services (HHS) has issued a proposed rule creating programs certifying health information technology. A temporary program would test and certify initial electronic health record (EHR) products for health care providers seeking incentive payments for “meaningful use” of certified EHR technology under the Medicare and Medicaid EHR Incentives Program. It would then be replaced by a permanent program that separates testing and certification responsibilities, introduces accreditation requirements, establishes requirements for certification bodies and allows them to certify technologies besides EHRs.

For more information about the proposed rule, go to http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=1746.

The Department of Health and Human Services (HHS) has issued a proposed rule creating programs certifying health information technology. A temporary program would test and certify initial electronic health record (EHR) products for health care providers seeking incentive payments for “meaningful use” of certified EHR technology under the Medicare and Medicaid EHR Incentives Program. It would then be replaced by a permanent program that separates testing and certification responsibilities, introduces accreditation requirements, establishes requirements for certification bodies and allows them to certify technologies besides EHRs.

For more information about the proposed rule, go to http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=1746.