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The Ryan-Wyden proposal would reform Medicare from the bottom up, giving Americans the power to choose the health care plan best for them. Private markets and the government would compete for business according to who can offer the best prices and plans. President Obama's plan reforms Medicare from the top down. Elected officials would determine the rates of growth and reimbursements and mandate those to hospitals and doctors.

The Centers for Medicare and Medicaid Services (CMS) has released the 2012 Medicare Physician Fee Schedule (MPFS) rates final rule. The payment rate adjustment is effective for services delivered on or after January 1, 2012. As you will note, the announced rate reflects a 27.4 percent SGR downward adjustment. This downward adjustment is slightly less than the 29.5 percent reduction previously projected by CMS. Unless Congress intervenes to prevent this cut from taking place, physicians will ​

Coverage of hepatitis immunizations and coding for flu vaccine are important highlights in the Medicare guide. Note that 90658 is no longer a covered code and that the appropriate Q code must be selected. The Q codes correspond to vaccine manufacturers. Many providers find it helpful to enroll in a CMS electronic mailing list to keep up with changes in the Medicare reimbursement rates.

Practice Management recently exhibited at the 2011 Regional Medicare Conference. This conference is geared toward suppliers who bill claims or communicate with the Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor.

Practice Management recently exhibited at the North American Spine Society’s 26th Annual Meeting. NASS is a distinguished leader in advancing quality multidisciplinary spine care. They are a league of spine specialists with a passion to help spine care providers and patients by fostering quality, evidence based and ethical spine care. Its vision is to continue advancing multidisciplinary spine care through services, membership and outreach initiatives.

Dr. Postma recently joined the CMS staff as one of several Medical Officers for the Center for Medicare Management (CMM). A neurologist by training, Dr. Postma’s most recent work included a role in the Senate Finance Committee on Healthcare Reform (PPACA). During our meeting, Dr. Postma provided HBMA with an educational overview of Accountable Care Organizations (ACOs) a “new” shared savings program legislated under PPACA (Health Care Reform).

Denied claims and appeals are the most challenging aspects of the medical reimbursement process. Despite aggressive follow up on a recent claim by Practice Management staff, the insurance company continued to reject the claim each time it was resubmitted presenting a new reason for denial even though the service was pre-certified and the claim was filed within a few days of the service date.

The American Medical Association's (AMA) National Health Insurer Report Card (NHIRC) provides physicians and the general public a reliable and defensible source of critical metrics concerning the timeliness, transparency and accuracy of claims processing by health insurance companies. Billions of dollars in administrative waste would be eliminated each year if third-party payers sent a timely, accurate and specific response to each physician claim.

Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorizes a new and separate incentive program for eligible professionals who are successful electronic prescribers as defined by MIPPA. This new incentive program, which began on January 1, 2009, is separate from and is in addition to the quality reporting incentive program authorized by Division B of the Tax Relief and Health Care Act of 2006 - Medicare Improvements and Extension Act of 2006.

In the Balanced Budget Act of 1997, Congress mandated that payment for the majority of services provided to beneficiaries in a Medicare covered SNF stay be included in a bundled prospective payment made through the fiscal intermediary (FI)/A/B Medicare Administrative Contractor (MAC) to the SNF. These bundled services had to be billed by the SNF to the FI/A/B MAC in a consolidated bill.