Medicare Compliance & Reimbursement
CMS Pushes Self-Referral Ban For PET Scans
Nuclear medicine also on chopping block. Nuclear Medicine Pull Puzzles Experts "Why nuclear medicine was carved out I'm not sure, because nuclear medicine services are very similar to X-rays and ultrasound," says Barbara Grant, a principal with Gates, Moore and Company in Atlanta.
Physicians could have a much harder time performing PET scans and nuclear medicine tests if a new proposal goes through.
The Centers for Medicare and Medicaid Services wants to make diagnostic nuclear medicine and PET scans Designated Health Services under the Stark self-referral law, according to the 2006 Physician Fee Schedule proposed rule.
Under the Stark law, physicians who examine patients can't provide DHS themselves, because that's considered DHS self-referral. Physicians will also be prohibited from sending patients to any facilities that they have an ownership interest in.
Currently, DHS includes X-rays, ultrasounds, CT, MRI and bone densitometry tests. The category doesn't include any procedures that require the doctor to insert a needle, catheter, tube or probe into the skin or a "body orifice." But DHS hasn't included nuclear medicine and PET scans until now.
CMS argues that nuclear medicine and PET scans "pose the same risk of abuse" as radiology and imaging services. When CMS was preparing the Stark rules, nuclear medicine procedures mostly happened in hospitals, so they were already covered under the Stark law. Also, CMS barely covered PET scans in 2000, but Medicare has started to pay for PET scans for many conditions since then. Nuclear medicine services provided to Medicare patients increased 85 percent from 1999 to 2003.
When a managed care organization stopped paying non-radiologists for some kinds of imaging but allowed them to refer to radiologists, imaging services declined 20 to 25 percent, according to a report in the Journal of Radiology. CMS says this proves physicians order more imaging tests when they make money on them. Some consultants have been encouraging physicians to get into joint ventures to buy diagnostic nuclear medicine machines because the Stark rules don't cover them, CMS claims.
If the agency goes through with its proposal to include nuclear medicine in the DHS list, however, physicians will have to divest their ownership or investment, or else be unable to bill Medicare.
Medicare Compliance & Reimbursement
- MEDICARE ADVANTAGE:
A Dream Deferred- Regional PPO Plans Face Obstacles
Many won't be able to comply until 2007.
Health plan providers see great possibilities in the [...] - HOSPITALS:
Ambulance Services Added To Billing Duties
Independent contractors will look to facility for reimbursement.
When an ambulance transports an inpatient between his [...] - PHYSICIANS:
CMS Pushes Self-Referral Ban For PET Scans
Nuclear medicine also on chopping block.
Physicians could have a much harder time performing PET scans [...] - PHYSICIANS:
Medicare Offering Exemption Waivers
Burden on provider to prove patient hardship.
A new proposal might play a big role in [...] - PHYSICIANS:
Brakes Applied To Drug Bidding Program
Drugs may be available through vendors by July 2006.
The Centers for Medicare and Medicaid Services [...] - REHAB:
Live Appeals Hearings Headed Toward Extinction
Expert fret over rule change that may damage appeal chances.
Under the new appeals system, adjudicators [...] - REHAB:
Rule Reduces IRF Outlier Thresholds
...but it will also cut standard payments.
Good news for inpatient rehab facilities: The Centers for [...] - LONG-TERM CARE:
Providers Get Ready: New Pay System Starting Soon
Feds show no signs of slowing new PPS implementation.
Long-term care providers should not let early [...] - LONG-TERM CARE:
Hello QIO? Providers Can Profit From A Call
'8th Scope Of Work' now underway.
Providers that are looking for a way to edge ahead [...] - ENFORCEMENT WATCH:
Bad Consultants Are The Clinic's Problem, Too
Physical therapy clinics come under fire for Medicare and Medicaid fraud.
Physical therapy providers should only [...] - PHARMACEUTICALS:
Ad Rules: Drug Makers Doing It For Themselves
Critics question appropriateness of PhRMA making DTC ad guidelines.
The trade association that represents most of [...] - BILL WATCH
The following bills were introduced in the House: H.R. 3423. A bill to amend the [...]
