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Medicare Compliance & Reimbursement

Physicians:

Immunize Yourself Against Losses On Vaccines

Published on Sun Nov 21, 2004

Physician fee schedule contains good news on other drug payments as well.

Think oncologists are the only ones receiving some help in the new fee schedule with dispensing drugs? Look a little closer.
 
Payments for vaccines will also shoot up, Centers for Medicare & Medicaid Services Administrator Mark McClellan told a media conference call Nov. 3. For example, payments for administering the influenza vaccine will go up 100 percent in January.
 
Separately, a final rule for outpatient prospective payment included a 3.3 percent inflation update, and large payment boosts for diagnostic mammograms, colonoscopies and other preventive services. And a third regulation moved inpatient psychiatric care to a prospective payment system, which McClellan said would improve efficiency.
 
The physician fee schedule rule includes second quarter data on drug prices, but McClellan said he doesn't expect to see much change in the third quarter data.
 
Another important achievement in the new rule: A $57 dispensing fee for inhalation drugs (or $88 for a 90-day period). The Government Accountability Office had complained that Medicare planned to cut inhalation drugs steeply without providing any payments for dispensing them. So Medicare added the payment, which McClellan cautioned was only a transitional amount and might decrease in future years.
 
In addition to all the new drug administration codes, physicians will be able to bill separately for high-level evaluation and management services, critical care or prolonged services if your patients suffer an adverse reaction to chemotherapy drugs, McClellan noted. And CMS wants to work with oncology associations to help oncologists join purchasing groups and obtain the least expensive drugs.
 
Medicare will save only about as much on oncology services as Congress had predicted when legislators passed the Medicare Modernization Act, McClellan said. All in all, payments will decrease about 6 percent. These savings are in line with what "stakeholders," including oncologists, agreed to in the negotiations leading up to the MMA, he said.

 

 

 

 


 
 Tougher compliance measures for medical laboratories are brewing in Washington.
      On the heels of a Medicare scandal in which Maryland General Hospital allegedly gave 450 patients questionable HIV and Hepatitis-C tests, U.S. Representative Elijah Cummings (D-MD) has introduced the Clinical Laboratory Compliance Improvement Act of 2004 aimed at ensuring all labs comply with federal standards.
      The bill requires:

     

  • more protections for employees who alert authorities to violations;

         

  • labs to post a "conspicuous notice" informing employees how and to whom to report problems and what whistleblower protections apply to them under federal law;

         

  • more oversight and information sharing between the Centers for Medicare and Medicaid Services, state health agencies and private laboratory accrediting organizations regarding reports of deficiencies and investigative activity;
         
  • standard accreditation surveys conducted without prior notice; and

         

  • an annual report by the Secretary of the Department of Health and Human Services.

          During two congressional hearings in July, two former MGH employees testified that the fear of retaliation for reporting lab problems hindered immediate action on unsafe lab activities. The hearings also determined that miscommunication between various inspecting agencies, as well as advance warnings of impending inspections allowed the lab to cover up violations and perpetuate unsafe lab operations.
          "The hearing gave us little assurance that what was occurring at Maryland General was an isolated incident," Cummings said.
          Lesson Learned: Labs may need to prepare for tougher federal oversight coming down the pike.

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