Claims Paid Under the Medicare Physician Fee Schedule

To the extent possible, the Centers for Medicare & Medicaid Services (CMS) is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other Fee-For-Service (FFS) providers of services paid under the Medicare physician fee schedule, beginning July 1.  In this regard, CMS has instructed its contractors to hold these claims for the first 10 business days of July, for dates of service in July.  This should have minimum impact on provider cash flow because, under current law, electronic claims are not paid any sooner than 14 days (29 days for paper claims) after the date of receipt.  Meanwhile, all claims for services delivered on or before June 30 will be processed and paid under normal procedures. 

After 10 business days, contractors will begin releasing claims into processing under the fee schedule which implements current law.  This, of course, could result in claims being processed with the negative 10.6 percent update.  If a new law is enacted which changes the negative 10.6 percent update, retroactive to July 1, CMS is prepared to automatically reprocess most of those claims which have already been processed. 

Under the Medicare statute, Medicare pays the lower of submitted charges and the Medicare fee schedule amount.  Claims with dates of service July 1 and later billed with a submitted charge at least at the level of the January 1-June 30, 2008, fee schedule will be automatically reprocessed if Congress retroactively reinstates the update that was in effect for that time period.  Any lesser amount will likely require providers to re-submit a revised claim. 

To the extent possible, providers may hold claims in-house until it becomes clearer as to whether new legislation will be enacted or until cash flow becomes problematic.  This will reduce the need for providers to reconcile two payments (i.e., the initial claim and the reprocessed claim), and it will simplify provider billings of beneficiary coinsurance and payment calculations for payers which are secondary to Medicare. 

Doctors Win a Reprieve from Medicare Pay Cut

From the Wall Street Journal Health Blog:

The brinkmanship over Medicare’s payments to doctors has gone to a new level.

For those of you new to the issue, a quick summary: A few years back, Congress created a Medicare funding formula that suggests payments to physicians should be cut. But each year, just before the pay cut goes into effect, Congress steps in and blocks it with a temporary measure.

The current temporary measure is set to expire tomorrow, when a 10.6% cut is scheduled to take effect. Last week, the Senate narrowly failed to pass a bill that would have blocked the pay cut.

Medical helicopters collide at hospital


At least seven people died and three were critically injured after a midair crash between two medical helicopters at an Arizona hospital on Sunday, authorities said.

At least one person killed in the crash, which occurred at 3:45 p.m., was a patient, according to FAA communications manager Ian Gregor.

The patient and two others were aboard a Bell Jet Ranger helicopter operated by Air Methods Corporation, an air medical service provider, Gregor said.

Iowa Floods Affecting Hospice Care

From Pallimed:

By now the news about the 2008 Midwestern flood is no longer the lead story in the news cycle. The president has been to some of the affected areas, and the presidential candidates have stopped by as well. Disasters of this magnitude affect the health care in a community because your coronary plaque or impending stroke isn’t going to wait for the flood water to recede. A good friend of mine David Wensel, DO is a hospice & palliative medicine physician for Hospice of North Iowa in Mason City, IA, and he was kind enough to answer some questions about how the floods affected hospice operations during a disaster.

Proposed rule would alter rural-clinic regulations

From Modern Healthcare (free subscription required)

The CMS has issued a proposed rule that would update certification and participation regulations, as well as payment provisions, for rural health clinics and federally qualified health centers.

In addition to establishing location requirements—such as clinics being located in nonurbanized areas defined by the U.S. Census Bureau—and exception criteria for rural health clinics, the rule would also require rural health clinics to establish a quality assessment and performance-improvement program. It would also revise the payment methodology to be consistent with statutory requirements that set Medicare payment at 80% of reasonable costs after application of deductibles. And it would clarify circumstances in which a rural health clinic and a Medicare Part B physician practice, or a Medicaid fee-for-service practice, could operate simultaneously.

Medicare Pricing Frozen As Congress Leaves Town

From the Washington Post:

With congressional leaders engaged in heated brinkmanship, the Bush administration yesterday gave a reprieve to thousands of doctors expecting to get hit Tuesday with a 10.6 percent cut in Medicare payments.

The Department of Health and Human Services will essentially freeze the current pricing system because Congress left town yesterday for a midsummer break without approving a price fix, Secretary Mike Leavitt announced. Congressional aides said the freeze could last 10 days.

If the legislative dispute lasts beyond the new deadline, Leavitt said he hopes to retroactively pay doctors once the dispute is resolved.

But there was no sign of cooling off on Capitol Hill. Yesterday, each side accused the other of playing politics with Medicare, the program that covers many health-care costs for the nation’s elderly and some people with disabilities.

Feelings were particularly raw after a Thursday night Senate vote in which members yelled at one another on the floor and left Democrats one vote short of the 60 needed to pass their version of the Medicare fix.

Bill Blocking Medicare Pay Cuts to Docs Stalls in Senate

From the Wall Street Journal Health Blog:

Time after time, Congress has jumped in at the last minute to block Medicare payment cuts to doctors. Will this be the time when time runs out?

A bill to block a 10.6% reduction in Medicare reimbursements stalled in the Senate yesterday. The cuts will take effect on July 1 — and a weeklong congressional recess starts tomorrow.

Republicans and Democrats seem to agree that the cuts are a bad thing. And a bill blocking them passed the House by an overwhelming 355-to-59 vote.

But Senate Republicans (and President Bush) don’t like the way the bill finds money for docs by cutting subsidies to Medicare Advantage, the privately administered Medicare plans. A procedural vote yesterday was 58-38 in favor of the legislation — but 60 votes were required for the bill to move ahead.

John McCain didn’t vote on the bill; Obama voted in favor. Here’s a list of how everyone voted. The WSJ notes that several of the nine Republicans who voted for the bill are facing tough re-election races.

Patient Feedback More Important Than Ever to Hospitals

From ACHE News (referencing Pantagraph):

The latest trend in hospital patient care is to encourage patients and their relatives to express concerns, compliments or suggestions to medical staff before the patient is discharged or complications arise. Many hospitals have polled patients for some time, but more are publicly disclosing survey results as part of the federal Hospital Compare Web site. This Web site allows patients and their families to evaluate healthcare facilities based on the level of communication between staff and patients and whether patients would recommend the hospital to friends and relatives. Because treatment is administered more quickly, communication is critical for medical professionals to know whether the treatment is working or not. Mark Dabbs with OSF St. Joseph Medical Center in Bloomington, Ill., reports that patients need to speak up and ask questions so that they can get a realistic idea of what to expect in terms of treatment. Dabbs and Clinical Director Stephanie Moore with the BroMenn Regional Medical Center advise each patient to designate a family representative that staff can talk to if the patient is unable to receive information. Establishing good communication between patients and staff early on can reduce patient anxiety about raising concerns or asking questions about treatment. Experts recommend hospitalized patients ask questions about their condition, the recommended procedure, possible side effects and the duration of recovery. Other questions should touch upon pain management, length of hospitalization and when solid foods can be eaten.

Experts Predict Visits by Baby Boomers Will Soon Strain Emergency Departments

From ACHE News (referencing JAMA):

The U.S. Centers for Disease Control and Prevention reports a disproportional increase in the number of emergency department patients aged 65 years or older. Although emergency rooms are equipped to see patients of all ages, the aging of the Baby Boomer generation could lead to overcrowding because those patients are often sicker and more likely to be admitted. An analysis of data from the National Hospital Ambulatory Medical Care Survey found that overall visits by people between the ages of 65 to 74 increased by 33 percent between 1993 and 2003. The average admission rate did not change dramatically, which suggests the increasing number of emergency patients is related to an increase in emergency problems. Hospitals already facing staff shortages and budget cuts may not be able to provide the same level of care when emergency departments are overcrowded, say experts. Older patients require more attention, so hospital staff will be able to see less patients in a day, impacting care for all visitors. One expert suggests that hospitals develop new screening and intervention techniques to reduce the need for emergency services. Improved prescription education, better community services for the elderly and stronger relationships between primary care physicians and patients could help reduce the demand for emergency services. Critics warn that hospitals will need to offer higher pay and obtain Medicare reimbursement hikes for geriatric specialists in order to bolster the workforce to meet demand.

EMTALA Flexibility Proposed to Relieve On-Call Shortages

From ACHE News (referencing American Medical News)

In April, the U.S. Centers for Medicare & Medicaid Services (CMS) proposed a modification to its on-call rules under the Emergency Medical Treatment and Labor Act (EMTALA). CMS proposed allowing hospitals with emergency departments to form community call plans. According to the rule change, community on-call plans would provide regions with greater care flexibility and ease the burden of physicians who find it hard to maintain their taxing emergency on-call schedule because of specialty shortages throughout the system. Additionally, experts believe the rule clarification will reduce Medicaid patient dumping. While the on-call change would allow one facility to be the on-call site for a particular period or service, or both, hospitals with emergency departments are still required to provide medical screenings and create patient care plans for emergency patients if an on-call physician is unavailable. Community call arrangements would not require pre-approval from CMS, but CMS would examine them if any EMTALA breaches occur, which can lead to fines and Medicare participation rights terminations. According to the EMTALA Technical Advisory Group, the added flexibility of community call plans would help alleviate hospitals’ on-call problems. However, some physicians, like American College of Emergency Physicians President-Elect Nicholas Jouriles, have expressed doubt about the effectiveness of community calls, especially in the absence of details from CMS.