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Senate to consider restrictions on imaging self-referrals

According to Modern Healthcare Online, Sen. Chuck Grassley (R-Iowa) is planning to introduce a bill that would require referring physicians to disclose any ownership interest they may have in an imaging service and to offer Medicare beneficiaries a list of alternative providers. The so-called Medicare Imaging Disclosure Sunshine Act of 2008 is based upon recommendations from the Medicare Payment Advisory Commission.

The AAOS supports appropriate disclosure to patients of physician ownership interest in ancillary services. The AAOS believes, however, that the increases in medical imaging utilization are driven by good patient care, and that patients' access to healthcare services may suffer if restrictions are imposed on physicians' ability to provide in-office imaging.
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South Carolina

According to the Greenville News, the South Carolina Department of Health and Human Services has set up a Web site that will allow interested parties to track spending in the state’s Medicaid program. The move is part of an initiative to improve government transparency, and provides reimbursement data about all of the hospitals and physicians who participate in the state’s Medicaid program.
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CMS announces results of first PQRI incentive program

Medicare will pay more than $36 million to healthcare providers who satisfactorily reported quality information under the 2007 PQRI, according to data released by CMS. The average incentive amount being paid to individual professionals is more than $600, and the average incentive payment for a physician group practice is greater than $4,700, with the largest payment to a physician group practice totaling more than $205,700. About 56,700 physicians and other professionals met the statutory requirements for satisfactory reporting during the 2007 reporting period and will receive incentive payments. Eligible providers should receive their payments by August 2008.
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E-prescribing will earn bonus payments from Medicare

The Medicare Improvements for Patients and Providers Act of 2008, enacted July 15, 2008, requires incentive payments to successful electronic prescribers for 2009 through 2013 (2.0 percent for 2009 and 2010; 1.0 percent for 2011 and 2012; 0.5 percent in 2013). This payment will be made in addition to incentive payments paid as part of the Physician Quality Reporting Initiative (PQRI) and other Medicare reimbursements. The Centers for Medicare and Medicaid Services (CMS) added e-prescribing as a quality measure this year. Bonus payments will be phased out after 5 years and physicians who have not adopted e-prescribing will generally be reimbursed at lower rates.
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Fight to pass Medicare bill continues in the Senate

The New York Times reports that physicians across the United States have begun to reassess their participation in Medicare in the wake of the failure of the U.S. Senate to address the 10.6 percent reduction in reimbursement that went into effect on July 1. Before Congress recessed for the Independence Day holiday, the House of Representatives had passed a bill that would replace the cut by continuing the 0.5 percent increase over 2007 rates already in place, and implementing a 1.1 percent increase in 2009. However, the bill fell one vote short of achieving cloture in the Senate, and President George W. Bush has threatened to veto it. To limit disruptions of Medicare physician payments, the Centers for Medicare and Medicaid Services (CMS) is not processing Medicare physician fee-for-service claims dated July 1 and thereafter and has instructed its contractors to hold the claims during the first 10 business days in July.
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CMS releases proposal for 2009 Medicare physician fee schedule

The U.S. Centers for Medicare and Medicaid Services (CMS) has released its proposal for changes under the 2009 Medicare physician fee schedule. The proposal includes a statutory reduction in spending of 5.4 percent. Total Medicare spending under the 2009 physician fee schedule is projected at $54 billion, down 5 percent from the $57 billion projected for 2008. CMS is also proposing additional improvements to the Physician Quality Reporting Initiative (PQRI). Increasing the number of conditions covered by measures groups to nine; adding rheumatoid arthritis, care during surgery, and back pain to the original measures groups are among the suggested changes.
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Medicare Claims Processing after July 1

Congress recessed without resolving the Medicare payment fix and will revisit legislation after the July 4th recess. In order to limit disruptions of Medicare physician payments, the Centers for Medicare and Medicaid Services (CMS) will not process Medicare physician fee for service claims dated July 1 and thereafter, during the first 10 business days in July, instructing their contractors to hold the claims. Under current law, electronic claims are not paid until 14 days (29 days for paper claims) after the date of receipt, so this action should have minimal impact on provider cash flow. Claims for services provided July 1 and thereafter should reflect the same rates paid for services during the first half of 2008; however, patient co-payments should be collected based on the revised fee schedule effective July 1, as provided by the Medicare carrier. Medicare will make payments and adjustments once the legislature resolves the Medicare physician payment issue. Watch for email updates here and via AAOS Advocacy Now.
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