Krieg DeVault, LLP attorneys presented a compliance update for medical groups at the ISMA, detailing key policy and enforcement changes arising from the Patient Protection and Affordable Care Act (PPACA). In an overview, the presenters discussed audit and enforcement trends, claims issues, fraud and anti-kickback statute changes, payment and other issues of significance for medical practices.
Here are some highlights from the session; see Part I regarding enforcement, audits and claims.
A primary care physician (family practice, general medicine, geriatrics and pediatrics) whose office, nursing home and home visits comprise at least 60 percent of Medicare charges will be eligible for a 10 percent bonus for certain Evaluation and Management (E&M) services from 2011-2016. “Physicians must request this,” said attorney Leeanne Coons. Guidelines will be issued about filing and the bonus will be paid quarterly.
All general surgeons performing major procedures with a 10- or 90-day global period in a health professional shortage area also will be eligible for a 10 percent bonus for certain services delivered in 2011-2016.
Coming in 2013 and 2014, Medicaid pay to primary care physicians delivering certain E&M and immunization services can be no less than 100 percent of Medicare Part B pay.
Centers for Medicare & Medicaid Services (CMS) officials have confirmed they are raising the discount for multiple imaging services performed on contiguous body parts (like CT of abdomen and pelvis) in a single patient session – from 25 to 50 percent. Thus, Medicare will pay 100 percent of the allowable amount for the highest priced procedure, and 50 percent of the allowable amount for all additional procedures within the same “family.” This is for the technical component only; the professional component (radiologist) fee is not subject to this change.
Increased pay for nurse midwives
Starting Jan. 1, 2011, Medicare will pay nurse midwives 100 percent of the physician fee schedule amount for the same service furnished by a physician (or 80 percent of the actual charge if it is less).
Elimination of certain deductible, co-pays
For 2011, the Part B deductible and co-pays are waived for many preventive services; this applies to Grade A or B services including diabetes screenings, mammography, DEXA/PAP tests, PSA tests and many vaccines.
Annual wellness visit
Effective Jan. 1, Medicare will pay for an annual wellness visit, including personalized prevention plan services.
For questions regarding Medicare, you may contact Jeri Biedenkopf, R.N., ISMA practice advisor, or Krieg DeVault’s Leanne Coons at (317) 238-6269.