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MGMA believes ICD-10 compliance date is unrealistic.

A proposal by the U.S. Centers for Medicare and Medicaid Services (CMS) calling for full implementation of the International Classification of Diseases (ICD)-10 code sets by Oct. 1, 2011 provides an unrealistic time-frame for the conversion, according to a spokesperson for the Medical Group Management Association (MGMA). The proposed rule for the next generation of the Health Insurance Portability and Accountability Act (HIPAA) electronic transactions must be put in place prior to ICD-10, and MGMA believes that change will take several years for full implementation and testing. The U.S. Health and Human Services Department is currently accepting comments on the proposal.

The AAOS has been monitoring the proposed transition to ICD-10, and is actively engaged to ensure that the transition places as little administrative and cost burden on physician practices as possible.
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Revised Medicare Advance Beneficiary Notice of Noncoverage (ABN) form use begins September 1.

As of Sept. 1, 2008, CMS will require that physicians, practitioners, laboratories and suppliers begin using the revised ABN (CMS-R-131) form. The ABN is a required notice given to beneficiaries in Original Medicare to convey that Medicare is not likely to provide coverage in a specific case. The revised ABN replaces three existing forms: ABN-G (Form CMS-R-131G), ABN-L (Form CMS-R-131L), and NEMB (Form CMS-20007).
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Growing number of drugs seeing huge increases in price.

According to the Gannet News Service, a study conducted by researchers at the University of Minnesota finds that some pharmaceutical manufacturers have been quietly increasing prices for a small number of prescription drugs by 100 percent or more—driving up costs for insurers, patients, and government programs. In 2007, the average wholesale prices of 26 brand-name drugs increased by 100 percent or more in a single cost adjustment, up from 15 in 2004. During the first half of 2008, 17 medications have done the same. Drug companies have stated that such price hikes are often needed to cover the costs of keeping the drugs on the market.

The issue is of concern because the costs of Medicare-covered outpatient drugs and biologicals are included in setting the expenditure target for physicians’ services under the current Medicare sustained growth rate (SGR) formula, even though these items are not physicians’ services. The AAOS supports removing retroactively Medicare-covered outpatient drugs and other incident-to services that are included in the expenditure target as part of a fix to the SGR formula.

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