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Hello
In
this issue
Senate
Finance chairman releases Framework for Comprehensive Health Reform
Sen. Max
Baucus, D-Mont., just released the Framework
for Comprehensive Health Reform. A bipartisan group of six senators
will consider this 18 page document as they work to create a healthcare
reform bill. According to the introduction, it reflects “the group’s
conversations and the group’s work throughout the summer, including
throughout the August recess”. Sen. Baucus recently indicated his intention
to introduce legislation next week and hold a Senate Finance Committee
markup of the bill the following week.
Highlights
of the framework that should interest those in medical group practices
include proposals to:
- Replace the
scheduled 21.5 percent reduction in 2010 Medicare physician payments
with a 0.5 percent increase;
- Require that
all eligible health professionals participate in the Physician Quality
Reporting Initiative by 2011;
- Create a 10
percent bonus payment to primary care and general surgery providers
who practice in health professional shortage areas. Funding for this
bonus is offset by reducing payments for all other services by 0.5
percent;
- Establish
payment incentives for physicians if they are deemed to appropriately
order high-cost imaging services;
- Increase the
imaging utilization rate assumption for advanced imaging equipment
from 50 percent to 90 percent, which will result in lower
practice-expense payments for the technical component of services
using this equipment;
- Simplify
administration by “accelerating the development, adoption and
implementation of standard, consensus-based operating rules for four
HIPAA* transactions: eligibility verification, claims status,
payment/electronic funds transfer and remittance advice;”
- Expand the
Medicare physician feedback program and penalizing physicians who use
significantly more resources than their peers;
- Allow groups
of providers to form Accountable Care Organizations, improve quality
of care and share in half of the savings achieved over a three-year
period;
- Require all
individuals to have health insurance by 2013;
- Require all
employers with more than 50 full-time employees to pay a fee if they
don’t offer health insurance;
- Create the
Consumer Operated and Oriented Plan (CO-OP), comprising “nonprofit,
member-run health insurance companies”; and
- Establish
state-based health insurance exchanges.
MGMA
continues to meet with leaders in both the Senate and the House of
Representatives as healthcare reform legislation develops. It is now more
important than ever for you to contact your members of Congress through the
MGMA
Advocacy Center to urge repeal of the Medicare physician payment
formula and inclusion of meaningful administrative simplification
provisions in legislation. Visit the MGMA
Health Care Reform Center and read MGMA Washington Connexion for to
keep up with developments.
* Health
Insurance Portability and Accountability Act
CMS
clarifies that H1N1 codes took effect Sept. 1, announces telephone
listening session
The
Centers for Medicare & Medicaid Services (CMS) has created two new
procedure codes for vaccine administration for the H1N1 influenza virus.
G9142 (Influenza A [H1N1] vaccine, any route of administration) describes
the vaccine, while G9141 (Influenza A [H1N1] immunization administration,
including physician counseling of the patient/family) describes the
administration of the vaccine.
Although
original educational materials from CMS indicated that these codes took
effect on Oct. 1, the agency has since stated that they codes became
effective on Sept. 1. Additionally, CMS states that “Medicare will pay for
seasonal flu vaccinations even if the vaccinations are rendered earlier in
the year than normal.”
Although
Medicare typically pays for one flu vaccination a year, if more than one is
medically necessary (i.e., the number of doses of a vaccine and/or type of
influenza vaccine), Medicare will pay for them. CMS has notified Medicare
claims processing contractors to expect earlier-than-usual seasonal flu
claims, and states that it does not expect a problem in paying those
claims. If it is necessary for Medicare beneficiaries to receive both a
seasonal flu vaccination and an influenza A (H1N1) vaccination, Medicare
will pay for both. However, if either vaccine is provided free to a health
care provider, Medicare will only pay for the vaccine’s administration, not
for the vaccine itself.
Additionally,
the Department of Health and Human Services announced a H1N1 listening
session via a conference-call connection on Monday, Sept. 14, from 1:30-3
p.m. Eastern time to update the provider community about H1N1 preparedness
and response, vaccine availability and infection control. Interested
members should call 800.837.1935 and use conference ID 2H1N1.
Read the
entire CMS
educational article, review the 2008-2009
Immunizers’ Question & Answer Guide to Medicare Coverage of Influenza
and Pneumococcal Vaccinations, and review the Centers
for Disease Control & Prevention Novel H1N1 Influenza: Resources for
Clinicians Web page.
Prepare
for H1N1 by visiting the MGMA
Emergency Preparedness Resource Center.
Compliance
standards for consignment closets for DMEPOS delayed
On Sept.
1, the Centers for Medicare & Medicaid Services (CMS) delayed the
implementation of updated
compliance standards for consignment closets and stock and billing
arrangements for durable medical equipment, prosthetics, orthotics and
supplies (DMEPOS) to March 1, 2010.
In
consignment closets and/or stock and billing arrangements, an enrolled
DMEPOS supplier maintains inventory at a practice location owned by a
physician or nonphysician practitioner. The inventory is housed at the
practice location solely for distribution. Physicians and nonphysician
practitioners who maintain consignment closets and stock and bill
arrangements for DMEPOS must comply with National Supplier Clearinghouse
Medicare Administrative Contractor standards. These requirements include:
- Transferring
the title of the DMEPOS to the enrolled provider’s practice when the
DMEPOS are furnished to a beneficiary.
- Using the
provider’s billing number for DMEPOS supplies and services.
- Performing
services for fittings or use of the DMEPOS by individuals being paid
by the provider.
- Directing
beneficiaries with questions or concerns to the provider – not the
supplier that supplies the DMEPOS to the provider’s office.
CMS
announces additional free PQRI educational session
The
Centers for Medicare & Medicaid Services’ (CMS) will conduct a free national
conference call on the 2009
Physician Quality Reporting Initiative on Sept. 17 from 2:30 – 4:30
p.m. CMS representatives will provide an update on the 2007 and 2008 PQRI
recalculations, describe how to obtain the revised feedback reports,
discuss the PQRI and E-Prescribing Alternative Report Request Process and
take questions. Registration
for the call is required.
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