Medicare Payments to Improve in 2008

Posted on January 9, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

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Physicians Receive Temporary Reprieve

[By Staff Writers} 

Doctors will get a six-month reprieve from a 10.1 percent across-the-board cut in Medicare payments that was scheduled to go into effect January 1, 2008. 

In an effort to secure approval of the legislation, lawmakers decided to scale back its scope compared to earlier versions of the measure, but the bill still would provide for a number of Medicare policy changes, according to Reed Smith Health Industry Washington Watch.  

Other related policy changes and highlights of the bill include the following:

·  A 0.5 percent increase in Medicare physician fee schedule payments through June 30, 2008. Physicians would again face a steep payment cut in July 2008, however, requiring Congress to revisit Medicare policy in the New Year. The bill also would extend the five percent physician shortage area bonus payment and the work geographic index floor of 1.0 through June 30, 2008. 

·  An extension of the authorization and funding of the State Children’s Health Insurance Program (SCHIP) through March 31, 2009.

·  An extension of the Medicaid qualifying individual, Transitional Medical Assistance, and abstinence education programs through June 30, 2008.

·  A $1.5 billion reduction in the Medicare Advantage stabilization fund for regional preferred provider organizations in 2012, an extension of authority for specialized Medicare Advantage plans for special needs individuals, and a moratorium on new special needs plans and expanded service areas through December 31, 2009.

·  A provision to require CMS to adjust Part B drug average sales price (ASP) calculations to use volume-weighted ASPs based on actual sales volume, and to modify payment for the generic drug and sympatho-mimetic agent, albuterol [PROVENTIL HFA – albuterol sulfate].

·  Revisions to inpatient rehabilitation facility qualifications and payment policy, including a permanent freeze in the patient classification criteria compliance threshold at 60 percent (with co-morbid conditions counting toward this threshold) and a payment freeze from April 1, 2008 through September 30, 2009. 

Assessment

And so, although not an unexpected payment reprieve, how will these policy changes affect Medicare participating providers?

Conclusion

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2 Responses

  1. Janet, on January 31, 2008 at 6:42 PM said:

    Not So Fast!

    Of course, with Medicare payments to physicians in doubt for the final half of FY-2008, lawmakers and CMS already are thinking about physician fee-schedules for the last half of 2008 and in 2009.

    The six-month 0.5 percent boost is set to run out at the end of June and be replaced with a 10.1 percent reduction. This means that Medicare would cut doctors-pay across the board by 10.6 percent; from July 1 through the end of the year.

    Anticipating this, according to the American Medical News, Finance Committee members are working on an 18-month payment plan, instead of another six-month fix, so that an 18-month measure would put off the next round of scheduled cuts until 2010.

    This would also free Congress from negotiating a CMS 2009 payment update during the presidential election season.

    And so, is this just a matter of more politics as usual?

    Janet

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  2. Ann Miller RN MHA, on August 19, 2014 at 11:22 AM said:

    CMS to Withhold 1/3 of Provider Data as Open Payments Website Problems Mount

    The CMS has confirmed that it will withhold until next June about one-third of submitted records on drug and device industry payments to physicians and teaching hospitals because of suspected inaccuracies with data included on its Open Payments website. The decision comes as criticism of the agency’s implementation of the Physician Payments Sunshine Act provision of the Patient Protection and Affordable Care Act from healthcare providers and manufacturers mounts.

    But the CMS says it’s sticking with its plan to make the website accessible to the general public Sept. 30, and has extended the review period for doctors and teaching hospitals to Sept. 8. The CMS has found that about one-third of data is “intermingled”—meaning data on different doctors is mixed up—and therefore not appropriate for publication. While the precipitating issue was the name mix-up, that wasn’t the root cause behind all of the withheld data, said CMS spokesman Tony Salters, though he declined to delve into the exact issues behind the inaccurate data.

    Source: Darius Tahir, Modern Healthcare [8/18/14]

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