Medicare Compliance & Reimbursement

CHAMP Act could K.O. imaging reimbursement.

No more cliffhangers: The proposed Children's Health And Medicare Preservation (CHAMP) Act wouldn't just eliminate two years of spending cuts. It would get rid of the current system of payment updates, which has spelled steep cuts every year.

Instead of comparing all physician spending with the growth of the economy, the House bill would set up six different categories. Medicare would have separate targets for spending growth in:

· Primary and preventive services;
· Other evaluation & management services;
· Major procedures;
· Anesthesia services;
· Imaging services; and
· Minor procedures and other services Primary care gets a boost: The targets would expect primary care and preventive services to increase by the rate of growth in Gross Domestic Product (GDP) plus 3 percent.

But the other five service categories could only rise at the same rate as the GDP, with no add-on. If they grew faster than GDP, they could be targeted for their own cuts. This could be especially hard on imaging services, which have grown rapidly in recent years.

The good news is that these spending targets wouldn't take into account Part B drugs or laboratory tests. Medicare would report separately to Congress on the growth in those categories.

Congress might still need to pass more legislation later to avoid more cuts in 2010, warns the American College of Physicians (ACP) in a letter to leading House members. But the ACP still urged Congress to pass this bill. No More PQRI Bonuses For 2008 The 465-page CHAMP Act would also make the following changes:

Imaging crackdown: Facilities that provide imaging services would need to seek accreditation. Also, Medicare would assume that facilities use own their imaging equipment 75 percent of the time instead of 50 percent of the time, which could slash the practice-expense relative value units (RVUs) for imaging scans. Once again, if your physician scanned two contiguous body parts, Medicare would pay 50 percent less for the second scan--up from 25 percent less right now. And you would have to bill separately for every imaging service your physician provides, instead of billing globally.

More feedback: Medicare would give your physicians reports on how their practice patterns compare with those of other doctors in the same locality and nationwide. And physicians in counties that have the lowest health spending in the country could receive a 5-percent bonus.

But the bill would also do away with money to pay bonuses for the Physician Quality Reporting Initiative (PQRI) in 2008, so the PQRI would become strictly voluntary.

New and better bundling: The Government Accountability Office (GAO) would report to Congress on which services you currently bill together most often. Medicare could combine some of those services into one code [...]