Medicare Compliance & Reimbursement

If you've been wondering when CMS would finally clarify some of the more sticky issues involved in incident-to coding, that time has come.

On May 2, CMS issued Transmittal 87, which revises the incident-to guidelines. The main revisions involve CMS' inclusion of nonphysician practitioners (NPPs) in much of the language.

For instance, where the policy previously referred to a "physician's services," it now notes that it refers to a "physician's NPP's professional services."

You can find the new incident-to regulations on the CMS Web site at http://www.cms.hhs.gov/transmittals/downloads/R87BP.pdf.

• Practices are still waiting with bated breath to find out whether lawmakers will halt the expected 10.6 percent physician payment cut due to take effect on July 1.

Although congressional leaders seem to be taking their sweet time deciding whether to kill the cut for the remainder of 2008 or to let it take effect as planned, some lawmakers are working behind the scenes to put a stop to the proposed cuts.

Members of the Senate Finance Committee met on May 7 to discuss potential fixes to the payment cut, with attendees saying that a bill to stop the payment cut could be on the floor in early June.

• CMS will now cover artificial hearts when physicians implant them as part of an FDA-approved study, according to a May 1 coverage decision.

"Our decision revises a long-standing non-coverage policy and allows beneficiary access to this advanced technology," said Kerry Weems, CMS' acting administrator, in a statement.

CMS' coverage decision answers the questions that studies must address to meet the requirements for Medicare coverage, according to Weems' statement.

You can review the full decision on the CMS Web site at http://www.cms.hhs.gov/mcd/viewtrackingsheet.asp?from2=viewtrackingsheet.asp&id=211&.

• About one-quarter of disabled workers under age 65 who start receiving Social Security disability income are uninsured during the two years they must wait to obtain Medicare benefits, according to a recent study published on the Health Affairs Web site.

Employers cover about half of those in the waiting period, say researchers Pamela Farley Short from Penn State University and France Weaver from the Swiss Health Observatory in Neuchatel, Switzerland.

According to the study, by tracking each individual's health insurance from age 55 to age 65, Short and Weaver found that fully half of the people who lacked insurance during the Medicare waiting period were uninsured before they began receiving SSDI.