Medicare Compliance & Reimbursement

'Whole hospital' exemption could be on the chopping block.

The CHAMP Act, currently facing a vote in the House, features a grab bag of Medicare proposals that showcase Democrats' Medicare priorities, and could become law soon:

· Beneficiaries wouldn't have to pay 20-percent copayments or deductibles for current or future preventive benefits. The bill also specifies that colorectal cancer screening tests never count towards the patient's deductible--even if your physician finds something, removes some tissue or reaches a diagnosis.

· Physicians would no longer be able to own a stake in a specialty hospital and refer patients to it. Congress would abolish the "whole hospital" exemption, which allows doctors to refer patients to a hospital as long as they own a stake in the whole thing, not just part of it.

· Medicare would have the authority to pay for new preventive benefits without specific approval from Congress. The U.S. Preventive Health Services Task Force would have to recommend the preventive health benefits for coverage.

· The copayment for mental health services would drop from 50 percent to the standard 20 percent.

· Low-income seniors would find it easier to obtain financial help, especially with the Part D prescription drug program. The CHAMP Act would expand the Low Income Subsidy (LIS) and the Medicare Savings Program (MSP).

· You might also receive some extra reimbursement for helping your patients with Limited English Proficiency (LEP), if you live in an area covered by a proposed demonstration project.

· Provisions benefiting rural areas would gain an extension, including physician scarcity bonuses, and a geographic "floor" that makes sure rural practices don't earn less than the average for Medicare patients.