Medicare Compliance & Reimbursement

Congress continues to fight over the details of how to save your practice from a 10.1-percent pay cut, while time runs out.

The Senate Finance Committee held a closed meeting Nov. 7 to discuss ways to avoid cutting your payments. Committee chair Max Baucus (D-MT) wants a $30 billion package that avoids 2008's 10.1-percent cut and 2009's 5-percent cut. But ranking member Chuck Grassley (R-IA) still wants just a one-year suspension, which would leave you facing a 15-percent cut in 2009.

The committee considered cutting payments to Medicare Advantage plans to eliminate the physician cuts. But Republicans continue to oppose those cuts, and Democrats have a list of 10 or 12 other areas that could face cuts, according to CongressDaily.

Meanwhile, 30 senators wrote to Baucus and Grassley to insist that any legislation should avoid cutting payments for imaging services. In July, the House passed a bill that would have saved you from Medicare pay cuts -- but also would have imposed limits on the growth of imaging. Baucus has said he may target imaging services for some payment reductions in the new bill.

"These reductions are being proposed on top of the $13 billion of recently implemented cuts" to imaging services, said the Oct. 31 letter, drafted by Sen. Herb Kohl (D-WI). The letter urges the Finance Committee to "oppose additional cuts to these crucial medical imaging services."

• You'll have one less thing to worry about when Jan. 1 hits. The Centers for Medicare & Medicaid Services (CMS) has bumped back its requirement to include a National Provider Identifier (NPI) in all primary fields on the claim to March 1, CMS says in a recent message to providers. Starting in March, providers must use their NPI in the billing, pay-to and rendering fields.

"Failure to submit an NPI in the primary fields will result in your claim being rejected or returned as unprocessable beginning March 1, 2008," CMS warns.

Back in limbo: CMS will allow legacy numbers by themselves in secondary fields -- such as those for referring physicians -- "until further notice," the agency says. That's a backtrack from the agency's earlier instruction to use NPIs in secondary fields by May.

• CMS is on course with the transition to a new "bottom-up" method of calculating practice expense RVUs. This method relies on data from specialty society surveys instead of data from an old American Medical Association survey. Some specialties, which have less complete survey data, may lose out in the transition.