FOS

Congress to take up SGR fix, but too late to stop cuts.

The Hill reports that the U.S. Senate is prepared to consider a 19-month delay in Medicare reimbursement cuts currently mandated under the Sustainable Growth Rate (SGR) formula, but a vote may not take place until early next week. Observers say it is likely that physicians will begin receiving Medicare payments reflecting a 21.3 percent reduction starting June 15. The cuts went into effect on June 1, but the U.S. Centers for Medicare & Medicaid Services (CMS) has held off processing payments for 10 business days to give Congress time to act.
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“CMS Holding Claims as of June 2010 Pending Congressional Action on Physician Fee Schedule”

“The Continuing Extension Act of 2010, enacted on April 15, 2010, extended the zero percent (0%) update to the 2010 Medicare Physician Fee Schedule (MPFS) through May 31, 2010.  The Centers for Medicare & Medicaid Services (CMS) believes Congress is working to avert the negative update scheduled to take effect June 1, 2010.  To avoid disruption in the delivery of health care services to beneficiaries and payment of claims for physicians, non-physician practitioners, and other providers of services paid under the MPFS, CMS has instructed its contractors to hold claims containing services paid under the MPFS (including anesthesia services) for the first 10 business days of June.  This hold will only affect MPFS claims with dates of service June 1, 2010, and later. 

 

This hold should have minimum impact on provider cash flow because, under the current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt. 

Be on the alert for more information about the 2010 Medicare Physician Fee Schedule Update.”  

House passes two-month delay on SGR cuts.

Modern Healthcare reports that the U.S. House of Representatives has approved a fiscal 2010 defense appropriations bill that includes a rider to stave off cuts in Medicare reimbursement under the sustainable growth rate (SGR) formula through Feb. 28, 2010. Currently, a 21 percent reduction in Medicare reimbursement is planned to go into effect on Jan. 1, 2010. The Senate is scheduled to vote on the appropriations bill by Friday.
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CMS issues instructions on new reimbursement policy for consultation services.

The U.S. Centers for Medicare & Medicaid Services (CMS) has released detailed instructions for providers on how to adjust their coding for consultative evaluation and management (E/M) services. As of Jan. 1, 2010, CMS will no longer recognize Current Procedural Terminology codes 99241-99245 and 99251-99255, which reimburse physicians for providing consultative E/M services. Providers will instead be expected to use the appropriate new or established patient office, outpatient, or inpatient visit code. This change is effective for Medicare only; other carriers have not yet stated whether they will adopt similar policies for consultative services.
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Small percentage of Medicaid and CHIP enrollees account for majority of spending.

A study published online in the journal Health Affairs finds a strong contrast in demographic differences between heavy users and non-users of Medicaid and the Children's Health Insurance Program (CHIP). The authors found that 10 percent of enrollees in such systems account for 72 percent of the spending, and that 30 percent of enrolled children receive little or no care. Additionally, non-users receive little preventive care such as well-child visits and dental checkups, putting them at increased risk of having health problems that go undiagnosed and untreated. The authors state that the results highlight the importance of cost containment strategies designed to reduce avoidable hospitalizations.
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P4P improves performance in short-term at the expense of other factors.

The results of an English study on the effects of pay-for-performance (P4P) have been published in the New England Journal of Medicine. Although P4P accelerated improvements in quality for two of three chronic conditions in the short term, long-term effects were less pronounced, and quality of care declined for conditions not linked to incentives. The authors analyzed quality of care in 42 representative family practices, with data collected both before and after implementation of P4P in 2004. They found that, between 2003 and 2005, the rate of improvement in quality of care increased for asthma and diabetes (P<0.001) but not for heart disease. By 2007, the rate of improvement had slowed for all three conditions (P<0.001), and the quality of those aspects of care that were not associated with an incentive had declined for patients with asthma or heart disease. Compared to the period before P4P, the improvement rate after 2005 was unchanged for asthma or diabetes and was reduced for heart disease (P=0.02).

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Division of Workers Compensation Releases Report on Reimbursement Disputes and Overutilization

The Division of Workers' Compensation has submitted to the Three-Member Panel its Annual Report on Reimbursement Disputes and Overutilization. This notice is to advise all registered users of the DWC e-Alert system that the report is now available for public viewing on the DWC website: http://www.myfloridacfo.com/WC

According to the provisions of section 440.13(12)(e)4., Florida Statutes, "The Department shall provide the panel with an annual report regarding the resolution of medical reimbursement disputes and any actions pursuant to s. 440.13(8).:  This year's report provides a detailed accounting of the Petitions for Resolution of Reimbursement Dispute received and adjudicated as well as activity generated by Carrier Reports of Over-Utilization for Fiscal Year 2007-2008.

Uncompensated care cost each insured family $1,017 last year.

A report released by not-for-profit advocacy group Families USA states that subsidizing uncompensated health care for the uninsured cost insured American families an average of $1,017 each during 2008. According to the report, which was based on data from the Medical Expenditures Panel Survey and other federal and private sources, 37 percent of care is paid for out-of-pocket by the uninsured, with third-party sources such as government programs and charities, paying for another 26 percent of care for the uninsured. The remaining costs were considered uncompensated and totaled $42.7 billion across the United States in 2008.

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HEAT initiative created to chill purveyors of Medicare fraud.

The U.S. Department of Justice (DOJ) and the U.S. Department of Health and Human Services (HHS) have announced the creation of a joint task force to combat Medicare fraud. The Health Care Fraud Prevention and Enforcement Action Team (HEAT) will include senior officials from DOJ and HHS who will strengthen existing programs to combat fraud and invest in new resources and technology designed to prevent future fraud, waste, and abuse.
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Majority of Physicians Now Compensated for ER Call

Modern Physician reported on April 1st that according to a report released by the Medical Group Management Association that almost two-thirds (62%) of healthcare providers receive some form of additional compensation for on-call coverage.  The report notes that compensation agreements are in the form of a daily stipend or hourly rate with variations for specialty, group size and region.

See the full story, Most providers receive compensation for on-call duty, MGMA survey finds or go to www.modernphysician.com.