August 24, 2010 is the deadline for concerned health care providers or others to submit comments on regulations that the Centers for Medicare & Medicaid Services (CMS) recently proposed to implement key provisions in the Affordable Care Act of 2010 concerning Medicare reimbursement preventive services, primary care services, certain rural health care services, imaging and certain other services.  Health care providers providing Medicare-covered services should review the proposed regulation available here and an accompanying CMS Fact Sheet on the rule available here to assess its likely implications on their reimbursement and other operations act quickly to share any comments and concerns.

The proposed regulation published by CMS June 26, 2010 would apply to payments under the Medicare Physician Fee Schedule for services furnished on or after January 1, 2011.  Among other things, it outlines the conditions under which CMS proposes that:

• Medicare will cover an annual wellness visit
• Eliminate out-of-pocket costs for Medicare beneficiaries for most preventive services
• Add an incentive payment for primary care services furnished by primary care practitioners that can include physicians, nurse practitioners, clinical nurse specialists and physician assistants.  Implement a payment incentive program for general surgeons performing major surgery in areas designated by the Secretary as Health Professional Shortage Areas (HPSAs)
• Allow physician assistants to order post-hospital extended care services in skilled nursing facilities
• Pay certified nurse midwives for their services under the Medicare Physician Fee Schedule (MPFS) at the same rates as physicians
• Update its policies and payment rates for services by physicians, nonphysician practitioners (NPPs) and certain other suppliers that are paid under the MPFS during calendar year (CY) 2011. 
• Continue recent efforts by CMS to improve the accuracy of physicians’ payment rates by implementing Affordable Care Act mandates to identify services in categories that are at significant risk for inaccurate payment and by further reducing payments in CY 2011 for diagnostic imaging equipment used in diagnostic computed tomography (CT) and magnetic resonance imaging (MRI) services
• Require physicians referring CT, MRI and positron emission tomography (PET) services under the in-office ancillary services exception to the physician self-referral prohibition, to notify patients that they may receive the same services from other suppliers in the area. The physician would also provide a list of alternate suppliers.

The author of this update, attorney Cynthia Marcotte Stamer, has extensive experience advising and assisting health care providers and other health industry clients with reimbursement, compliance, public policy, regulatory, staffing, and other operations and risk management matters. You can get more information about her health industry experience here.  If you need assistance with these or other compliance concerns, wish to inquire about arranging for compliance audit or training, or need legal representation on other matters please contact Ms. Stamer at (469) 767-8872 or via e-mail here. 

Other Recent Developments

If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title:

• HHS Invites Comments On Health Center Program Federal Tort Claims Policy Manual
• NCPDP SCRIPT 10.6 Approved As Medicare Part D/Advantage E-Prescribing Option
• President Directs Quick HHS Action To Implement Physician Medicare Payment Restoration
• Proposed Medicare Rules Will Require Hospitals Honor Patient Visitation Preferences
• IRS Invites Input On Application of New Tax Exemption Requirements For Hospital Organizations Added By Affordable Care Act
• OIG Touts Expanding Health Care Fraud Enforcement Success & Launches New Health Care Fraud Hotline
• HHS Invites Input on Proposed Strategic Framework on Multiple Chronic Conditions
• New CBO Analysis Hikes Projected Affordable Health Care Act Cost by $115 Billion
• Pennsylvania Nurses Vote For Union In NLRB Election Highlights Rising Union Organizing Activity In Health Care Industry
• WellPoint To Ban Coverage Rescissions Before Affordable Care Act Fall 2010 Deadline
• DEA/DOJ Release Interim Final E-Prescribing Rules
• Joint Commission Revises Medical Staff Bylaw Standard
• IRS To Allow Medical Resident FICA Refund Claims
• Rising Enforcement and Changing Rules Require Prompt Review & Update of Health Plan Privacy & Data Security Policies & Procedures
• Pfizer To Pay $2.3 Billion For Fraudulent Marketing In Largest DOJ Health Care Fraud Settlement
• Maximum Penalty For Patient Protection Act Confidentiality Breaches To Rise To $11,000

For More Information

We hope that this information is useful to you. If you need assistance evaluating or responding to the Health Care Reform Law or health care compliance, risk management, transactional, operational, reimbursement, or public policy concerns, please contact the author of this update, Cynthia Marcotte Stamer, at (469) 767-8872, cstamer@Solutionslawyer.net.

Vice President of the North Texas Health Care Compliance Professionals Association, Past Chair of the ABA Health Law Section Managed Care & Insurance Section and the former Board Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has more than 23 years experience advising health industry clients about these and other matters. A popular lecturer and widely published author on health industry and human resources matters, Ms. Stamer continuously advises health industry clients about health industry and other related concerns. Ms. Stamer also publishes and speaks extensively on health and managed care industry regulatory, staffing and human resources, compensation and benefits, technology, public policy, reimbursement and other operations and risk management concerns. Her insights on these and other related matters appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications. For additional information about Ms. Stamer, her experience, involvements, programs or publications, see here.

You can review other recent health care and internal controls resources and additional information about the health industry and other experience of Ms. Stamer here. If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile at here or e-mailing this information here. To unsubscribe, e-mail here.

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This entry was posted on Saturday, July 3rd, 2010 at 1:08 pm and is filed under Health Care, Health Care Finance, Health Care Fraud, Health Care Provider, Health Care Reform, Hospital, Inpatient Rehabilitation Facility, Medicare, Medicare Advantage, Medicare Fee Schedule, Medicare Fee Schedule, Physician, Reimbursement, Rural Health Care. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.