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CMS has issued its 2009 Medicare fee schedule and some little tidbits that go along with the money. Physicians will not be getting the usual less money which has to be quickly changed by Congress yearly but will actually get a whole 1.1% increase. However, if Congress doesn't take action the 2010 pay will go down a whopping 21%. The 2009 increase is actually based on a lower conversion factor. Physicians who report measures under the Physician Quality Reporting Act will get an additional 2% increase and those who electronic prescribing will get an additional 2% increase for a potential increase of 5%. For diagnostic imaging there will be a decrease in multiple procedures on the same patient the same day. CMS has added 10 more procedures to the list that will be paid at the lower amount. CMS was originally going to require physician offices to have the same standards as hospitals but took that back after seeing the comments and after Congress passed a law that this must occur by 2012. CMS also changed the purchased and anti-markup rules. Now if a test is performed outside the physician's office ( the building where the billing physician provides most of his care) or performed or supervised by a physician who does not share a practice with the billing physician or physician organization there can be no markup in either the technical or professional components. CMS went on to change the retrospective billing from 23 months to only 30 days to make sure the new applicants were compliant with Medicare rules at the time of service. CMS believes this change is OK because a physician or a practice may apply on line within the time allowed. It behooves groups adding physicians to plan and do a clean enrollment application upfront.
The FTC has delayed until May 1, 2009, the "red flag" rule that would require physicians more headaches to keep patient information confidential. It is hoped that physicians and hospitals will be exempt from the rule.
HHS is continuing with the target date of 2011 for the implementation of the dreaded ICD-10. This will cost providers many thousands of dollars to implement in all practices. The hospitals are for the change as they don't care about costs and they feel they will make more money from each DRG under the new rules. The number of codes will increase ten fold. As an example instead of one code for angioplasty there will be 1170 codes. This is being done as a forerunner for national EMS. Expect a billing error rate of between 10% and 25% in the first year. Physicians may get fed up quickly with the codes and just state unspecified for a sprained ankle instead of a different code for each ankle and each bone of the ankle. Top
CMS has changed the wording for standing orders in the hospital setting. Now only the last page must be signed and dated and if there are changes to the internal pages these must be initialed. Also the orders can not allow people to practice beyond their scope of practice. Time of authentication need not be a barrier to medical care. Top
In the November election several important state issues were decided. South Dakota defeated an abortion measure that the legislators hoped would reach the Supreme Court. Washington passed an assisted suicide law that is essentially the same as Oregon's, which has been upheld by the US Supreme Court. Physicians and pharmacists are not forced to abide by the law if it is against their conscience.
Michigan has passed a medical marijuana measure that is sure to rankle the Feds. They also passed a measure to expand state stem cell research by the use of destruction of embryos.
San Diego, California, has done a great service to it's residents. It has passed a law that all new commercial buildings will need to have AEDs in their buildings. There will be training necessary as well as monitored upkeep. However, this law will save lives.
It should be noted that in the recent election, 14 physicians will be in the Congress. There are 10 Republicans and 4 Dems. This is a pickup of 2 more than in the last Congress. It is possible that there may be two more by the time the new Congress is seated. Top
DISCLAIMER: Although this
article is updated periodically, it reflects the author's point of view at the
time of publication. Nothing in this article constitutes legal advice. Readers
should consult with their own legal counsel before acting on any of the
information presented.