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Medicare Compliance & Reimbursement

INDUSTRY NOTES:

CMS To Spend More On Physician And Clinical Services In 2009

Published on Fri Feb 13, 2009

Plus: Payers may not honor new outpatient therapy cap amount until April, CMS says.

If the Centers for Medicare & Medicaid Services has its way, the salad days could be over soon.

This year, CMS will shell out six percent more

for Medicare physician and clinical services -- but that amount will drop next year, if the SGR formula goes into effect.

According to a Feb. 24 CMS press release, growth in national health expenditures will decelerate in 2010 to 4.6 percent, thanks to the projected 21 percent cut to Medicare physician payment rates required under the sustainable growth rate (SGR) "called for in 2010 under current law."

Potential good news: CMS does acknowledge in its press release that "in every year since 2002, Congress has acted to override application of the SGR formula to reduce physician payments."

Keep an eye on MLR -- we'll be following Congress and whether its members act to override the SGR for the coming year.

IN OTHER NEWS ...

• The outpatient therapy cap is $1,840 for 2009, but the claims system won't reflect that until April. It will reject therapy claims that exceed the 2008 cap amount of $1,810 until then, CMS says in Feb. 13 CR 6321 (Transmittal No. 1678).

You can simply resubmit the claim with the KX modifier for payment, CMS instructs in the memo online at  www.cms.hhs.gov/transmittals/downloads/R1678CP.pdf."Claims with KX modifiers shall circumvent the cap rejection in CWF," CMS says.

• If you try to bill Medicare for oxygen equipment repairs or service with HCPCS code E1340 after April 1, you won't get very far. Starting in April, DME MACs will begin denying E1340 claims with dates of service Jan. 1 or later, CMS says in a Feb. 13 transmittal outlining oxygen billing rules (CR 6296).The code will be replaced by K0739.

DME MACs also will no longer pay for K0740, although suppliers can use it to indicate non-covered charges, CMS notes.

• If you've grown frustrated with having to accept different policies from different Medicare carriers when collecting for sleep apnea testing, your troubles will soon be over.

That's because CMS has decided to establish a national policy that allows payment for these tests when a physician is initially diagnosing obstructive sleep apnea.

"This coverage decision establishes nationally consistent coverage and assures that beneficiaries who have sleep apnea can be appropriately diagnosed and referred for treatment," said CMS Acting Administrator Charlene Frizzera in a March 3 statement.

To read the new policy, visit www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=227.

• Congress members are getting their home care hopes onto the record. Sen. John Thune (R-S.D.) has reintroduced a bill that would create a pilot program giving HHAs incentives to use telehealth technology.

"Telehealth technology has the ability to dramatically change the way people in rural areas access high-quality health care," Sen. Thune says in a release.

And Rep. John Lewis (D-Ga.) has reintroduced legislation that would allow occupational therapists to make initial assessment visits for home care episodes, when OT is ordered in a therapy-only episode along with PT or SLP.The bill aims to let HHAs "assign the most appropriate skilled service to make the initial assessment visit," Rep. Lewis says in a release.

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