Medicare Compliance & Reimbursement

Get ready for pay-for-reporting, medication quality standards.

Good news: Congress acted at the eleventh hour to prevent a steep cut to physicians' reimbursement in January.

Not only does the new law eliminate your 5-percent pay cut for 2007, it also creates a fund to stabilize payments in 2008. Many physician organizations had been worried that Congress could get rid of the 2007 cut, only to end up with a 10-percent cut in 2008 to compensate.

The bill also called for:

· Pay for reporting. Starting in July, your practice can gain an extra 1.5 percent of Medicare reimbursement by reporting on quality measures developed by the American Medical Association and other physician groups.

Call your vendor now: You need to make sure your computer systems are up to the challenge of capturing and reporting these quality measures. If not, you have only six months to upgrade your systems to capture that extra Medicare reimbursement.

No P4P yet: The bill didn't include actual pay-for-performance (P4P) in which you would receive extra money if you follow quality guidelines. That may be coming in 2008, if legislators decide it's a good idea.

· Patient-centered medical home. Congress agreed to a demonstration project in which it will pay doctors in eight states a "care-coordination fee" for managing patients with multiple chronic diseases. The project would also give doctors a share of the money Medicare saves in the hospital and other settings from more efficient management of these patients.

"This is the first time that physicians, including those in smaller practices, will be given the opportunity to share in the savings that may result from physician-directed care coordination," said Lynne Kirk, president of the American College of Physicians.

· Payment floor. Rural areas with costs below the national average won't suffer from a drop in their reimbursement in January. Congress reinstated the "payment floor" which keeps their geographic payments at the national average.

· Medication safety. The final law will help prevent hospital medication errors by imposing quality standards, including medication safety measures such as electronic prescriptions, bar-coding of dosages and "smart" infusion pumps. Hospitals that fail to meet these standards will suffer reduced payment levels.