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Legal Update from Krieg DeVault LLP
e-Reports, Jan. 10, 2011
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2011 Physician Fee Schedule Final Rule shortens claims timeframes, offers bonus payments Untitled document

The Centers for Medicare & Medicaid Services (CMS) published its Payment Policies under the Physician Fee Schedule and Other Revisions to Medicare Part B for Calendar Year 2011 final rule in the Nov. 29, 2010, Federal Register. It finalizes several provisions of the Patient Protection and Affordable Care Act (PPACA) related to physician services. Significant changes include the following.

Maximum period for submission of Medicare claims reduced to not more than 12 months - The Final Rule finalizes new, reduced Medicare claims submission requirements. For services furnished on or after Jan. 1, 2010, the allowable period for submission of Medicare claims was reduced from three calendar years following the year in which services were furnished to one calendar year after date of service.

For services furnished before Jan.1, 2010, a bill must be filed no later than Dec. 31, 2010. The Final Rule also establishes certain limited exceptions to the new claims submission timeliness requirements.

Expanding access to primary care and general surgery services - Primary care physicians (family practice, internal medicine, pediatrics and geriatrics) and non-physician practitioners (nurse practitioners, certified clinical nurse specialists and physician assistants) whose Medicare charges for office, nursing home and home visits account for at least 60 percent of charges for such physician or non-physician practitioner will be eligible for 10 percent bonus payments for certain evaluation and management services from 2011-2016.

All general surgeons performing identified major surgical procedures (with a 10- or 90-day global period) in a Health Professional Shortage Area (HPSA) will be eligible for 10 percent bonus payments in addition to the amount otherwise paid for their services from 2011-2016.

Medicare coverage of annual wellness visit providing a personalized prevention plan - With the exception of the Initial Preventive Physician Exam, Medicare payment for routine physical check-ups has previously been prohibited. However, preventive care has become an increasing focus of the Medicare program. As such, Medicare will provide coverage for an annual wellness visit that includes and/or takes into account a health care risk assessment.

Patient payment responsibility for screening/wellness services - Effective Jan. 1, 2011, CMS will waive deductible and co-insurance amounts for most preventive services, including cardiovascular disease and diabetes screening lab testing, screening mammography, bone density testing and many vaccines. Medicare beneficiaries will incur no out-of-pocket costs for eligible preventive services.

For additional information, contact Leeanne R. Coons by e-mail or call (317) 238-6269.

Article written by Leeanne R. Coons of Krieg DeVault LLP, a law firm headquartered in Indianapolis with offices in Carmel, Noblesville and Schererville, Ind., as well as Chicago, Ill. and Atlanta, Ga. The statements in this article should not be construed as legal advice or legal opinion on any specific facts or circumstances. The contents are intended for general informational purposes only and you are urged to consult your own lawyer for any specific legal question.

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