Medicare Compliance & Reimbursement

CMS final rule also extends glaucoma screening benefit.

The Centers for Medicare and Medicaid Services has socked physicians with a feared pay cut for 2006, according to the newest Medicare Physician Fee Schedule final rule.

CMS will reduce physicians' payment rates per service by 4.4 percent in 2006, the agency announced Nov. 2.

"The current system is not sustainable, and the payment reduction offers further proof that we must move to a payment system that ensures adequate payments to physicians, but also supports high quality and efficient health care services," argues CMS administrator Mark McClellan.

In the final Medicare Physician Fee Schedule rule, CMS also:

• extends the glaucoma screening benefit to include Hispanic-Americans age 65 and older.

• provides supplemental payments to federally qualified health centers that contract with Medicare Advantage plans to encourage FQHCs' participation in the new MA program.

• changes Medicare payments for separately billable drugs and biologicals that end-stage renal disease facilities furnish, which results in a 1.2 percent increase in payment per treatment.

• provides a temporary add-on payment to cover additional preadministration-related services for locating and acquiring intravenous immune globulin due to market instability.

• establishes a new cancer quality demonstration for treating beneficiaries with one of 13 cancer types to track care coordination, treatment design and patient monitoring through CMS' billing system.

• includes diagnostic and therapeutic nuclear medicine services and supplies among the designated health services that are subject to the physician self-referral ban (this provision won't take effect until 2007).

CMS also reduced the dispensing fee for inhalation drugs after reviewing industry cost data and a September 2005 HHS Office of the Inspector General report. For 2006, CMS has established a $57 dispensing fee for a first-time 30-day prescription, a $33 fee for other months and a $66 90-day dispensing fee for inhalation drugs.
 
The agency has plans to develop a demonstration program for care management and coordination for inhalation therapy users "to determine whether such services have a positive impact on outcomes and reduce overall Medicare spending."

Find it online: For more information, go to http://www.cms.hhs.gov/physicians/default.asp?.