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Hello
In this issue
Senate
Finance Committee Chairman releases healthcare reform proposal
Sen. Max
Baucus, D-Mont., chair of the Senate Finance Committee, today released the
America’s
Healthy Future Act. Although not in legislative language form, the
Baucus indicated his intention to markup the bill in committee on Sept. 22.
We anticipate many amendments from both Republicans and
Democrats.
One of
the most notable differences between the House of Representatives version
of healthcare reform and the Senate proposal pertains to the Medicare
physician payment formula.
The
House of Representatives is considering a proposal that repeals the Part B
formula currently used to calculate physician reimbursement and resets the
historical debt accumulated by that flawed payment formula. The 21.5
percent reduction in physician payments for 2010 would be replaced with the
equivalent of the Medicare Economic Index, anticipated to be approximately
1 percent. In 2011 and subsequent years, the proposal would establish two
new expenditure targets linked to the gross domestic product, one for
primary and preventive health services and the other for all remaining
providers.
The
current Senate payment formula proposal replaces the scheduled 21.5 percent
reduction in 2010 Part B payments with a 0.5 percent
increase. Beginning in 2011, the proposal creates a 10 percent bonus
payment to primary care and general surgery providers who practice in
health-professional shortage areas. The funding for this bonus is offset by
a 0.5 percent reduction in payment for all other services. Steep cuts in
Medicare physician payments would then occur in 2011 and subsequent
years.
MGMA
will provide detailed information on specific provisions that affect
members and group practices when the full 220-page document has been
analyzed.
“Incident
to” billing on OIG’s agenda; MGMA offers Webinar to help practices comply
The
Office of Inspector General (OIG) of the Department of Health & Human
Services released a report examining billing for services of nonphysician
providers “incident to” a physician’s care. The OIG identified 250
physicians who used the services of nonphysician practitioners and found
that 21 percent of physician services not personally performed by physicians
were performed by “unqualified” nonphysicians. This means that the
nonphysicians lacked necessary licenses or certifications, had no
verifiable certifications or lacked the training to perform the service. In
addition, the OIG found that 7 percent of invasive services not performed
by physicians were performed by nonphysicians with inappropriate
qualifications.
These
findings have heightened scrutiny by the OIG and the Centers for Medicare
& Medicaid Services of “incident to” services. In particular, the OIG
looked at evaluation and management services provided by nonphysicians, as
well as ophthalmology, rehabilitation therapy, cardiovascular and
diagnostic radiology services. Billing for such services must fall within
current Medicare requirements.
Read the
OIG’s report, Prevalence
and Qualifications of Nonphysicians Who Performed Medicare Physician
Services.
To
assist your practice in complying with the “incident to” rules, we have
engaged experts in physician reimbursement to lead a member-focused,
interactive, 90-minute Webinar on Tuesday, Sept. 22. Robert J. Saner II,
Esq. and Rebecca L. Burke, Esq. will help you understand these difficult
rules during the presentation "OIG
targets ‘incident to’ claims – are you billing correctly?”
MGMA
2009 Annual Conference sessions to highlight critical advocacy issues
The
Medical Group Management Association (MGMA) will highlight a number of
critical legislative and regulatory healthcare issues facing physician
practices at the MGMA 2009 Annual Conference in Denver, Oct
.11-14. Advocacy-related sessions include:
- “Deciphering
Health Care Reform: What It Means to Your Practice” – Learn the
current status of healthcare reform efforts by the Obama
administration and Congress. Understand how these changes may affect
your practice from provider, employer and patient perspectives.
- “HITECH
Action Plan: EHR Incentive Payments and Practical Implementation
Issues” – Learn about the incentives for adopting electronic
health records (EHRs) and related regulatory issues under the
Health Information Technology for Economic and Clinical Health
(HITECH) Act, as well as practical guidance on the selection,
contracting process and implementation of EHRs.
- “Are You
Ready for the New HIPAA Privacy and Security Mandates?” – A new
federal law has greatly expanded the privacy and security requirements
for practices under the Health Insurance Portability and
Accountability Act (HIPAA). Practices must adopt policies and
procedures to avoid new enforcement provisions and significantly
higher penalties. One of the nation’s leading privacy experts will
describe these changes and their effect on your practice.
- “ICD-10 and
the New HIPAA Transaction Standards are Here! Critical Information Your
Practice Needs to Know” – The government now mandates adoption of the
latest HIPAA transaction standards and the replacement of ICD-9 with
ICD-10. This session will explore the impact on your practice, the
time frames for implementation and compliance, and the steps you need
to take to comply with these complex federal regulations.
- “Washington
Update” – This comprehensive session will describe how the
changes made in the Medicare program will affect your reimbursement
levels and practice operations. Speakers will address the Medicare
payment formula, including changes to the formula inputs, and tell you
how CMS modifies payments based on geographic area and the
services provided by your practice. This information is critical for
your practice’s contracting discussions with private payers.
Get more
information about the MGMA
2009 Annual Conference.
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