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As reported earlier, CMS released a final rule that sets Ambulatory Surgical Center (ASC) payment rates at 67 percent of the corresponding outpatient prospective payment schedule (OPPS).

As a result of heavy lobbying, this is a slight increase to the 62 percent of the OPPS rate included in the agency's earlier proposed rule. Also a result to ASIPP lobbying, CMS has soften the blow somewhat by transitioning this over a four-year period.

The ASC final rule allows ASCs to be paid for any surgical procedure that CMS determines doesn't pose a significant safety risk to Medicare beneficiaries when performed in an ASC and that isn't expected to require an overnight stay. As a result, the final rule adds about 790 procedures for ASC payment. Payments for procedures that have been performed predominantly in the office setting have been capped at the non-facility practice expense component of Medicare's Physician Fee Schedule in order to avoid creating an incentive for physicians to perform those procedures in ASCs.

2008 ASC Payment Rates

In addition, the agency also issued a proposed rule that would update Medicare payment for services in HOPDs under the OPPS and would set new payment rates for ASCs under the revised system effective for services in calendar year 2008.

See proposed HOPD rates

House Democrats on Tuesday introduced legislation that would reduce payments to Medicare Advantage plans and increase the federal cigarette tax by 45 cents per pack to fund SCHIP and make revisions to Medicare, the AP/Houston Chronicle reports (Freking, AP/Houston Chronicle, 7/24). The legislation, called the Children's Health and Medicare Protection Act, would reauthorize SCHIP and increase funding for the program by $50 billion over five years. The expansion would allow an additional five million to six million children to enroll in the program, according to House Energy and Commerce Committee Chair John Dingell (D-Mich.) (Kaiser Daily Health Report)

 Under the bill, a scheduled cut in Medicare payments to physicians would be reversed and physicians would receive a 0.5% increase in fees for each of the next two years. In addition, the bill would make revisions to the system that sets spending targets for Medicare outlays for physicians' care. Rather than setting a single spending target for all Medicare care, the system would sort outlays into six different categories with different spending targets for each category. The categories include: primary and preventive care; other evaluation and management services; anesthesia; imaging; major procedures; and minor procedures.

Senate Finance Committee Approves SCHIP Expansion Legislation The Senate Finance Committee on July 19 voted 17-4 to approve legislation that would reauthorize SCHIP and increase funding for the program by $35 billion over five years, the Los Angeles Times reports (Alonso-Zaldivar, Los Angeles Times, 7/20).

SCHIP expires on Sept. 30. Committee members on July 13 finalized an agreement on SCHIP reauthorization that would increase five-year funding for the program from $25 billion to $60 billion by raising the federal cigarette tax from 39 cents to $1 per pack.

Read more on Kaiser Daily Health Report, New York Times

Summary of House Bill

The ASIPP Comprehensive Pain Medicine Board Review Course will take place on Aug. 5-10 in Nashville, TN. Registration is still open for this six-day intensive Board Review course is perfect for physicians seeking board certification or re-certification for ABMS Pain Medicine examination or for American Board of Interventional Pain Physicians Part I examination.

The course is a CME activity which is geared to prepare physicians for their pain boards but can also serve an in-depth review of the specialty of pain medicine.

To register on-line or for more information on the review course or to register, visit our Web site.

Meetings

ABIPP Part I To Be Administered in August

ABIPP Part 1 exam will be administered in Nashville, TN, on Aug. 11, 2007 and registration is now open. The minimum requirements for eligibility are:

• A Primary ABMS or AOA board certification
• An active license to practice medicine in the UnitedStates
  

ABIPP

A new law intended to reduce health-care costs and increase access to treatment by giving nurses and other medical assistants greater latitude is expected to be signed by Gov. Rendell today. (Roarty, July 20, 2007, Philadelphia Inquirer)

The changes are said to ease the burden on doctors and allow some specially trained nurses to take advantage of their experience and expertise, said Rosemarie Greco, director of the Governor's Office of Health Care Reform.

As pharmacies in surrounding states use online databasesto outwit prescription pill abusers, Montana is becoming a draw for addicts seeking hydrocodone, oxycodone and other addictive painkillers, say officials with the Montana Board of Crime Control. (Ogden, July 25, 2007, Great Falls Tribune)

Thirty-two states nationwide, including Idaho and Wyoming, have electronic databases that allow pharmacies to share information on prescriptions of psychotropic drugs, opiate painkillers and other addictive medications. Montana's other neighbor, North Dakota, recently received a federal grant to plan and implement a monitoring system.

Great Falls Tribune

Purdue Pharma L.P., the maker of OxyContin, and three of its executives were ordered Friday to pay a $634.5 million fine for misleading the public about the painkiller's risk of addiction (Associated Press).

U.S. District Judge James Jones levied the fine on Purdue, its top lawyer and former president and former chief medical officer after a hearing that lasted about three-and-a-half hours. The hearing included statements by numerous people who said their lives were changed forever by addiction to OxyContin, a trade name for a long-acting form of the painkiller oxycodone.

MSNBC

The Part B Insider recently addressed the frequently asked question of "Can physical therapists (PTs) bill Medicare for their own services?" According to Pat Larabee, a coding specialist for InterMed, PTs can bill under their own provider numbers. Further, PTs can also bill "incident to" physician's services if they don't have their own provider numbers.

If the physical therapist is a member of a physician group, then they should bill the claims under the group's ID number, with the therapist listed as the rendering provider, according to Stephanie Fiedler of Loeb Troper of NY.

The bottom line is you should always check individual state requirements. Visit the CMS Website for more information on billing for PT.

NHIC's physical therapy billing guide

See CMS Billing Scenarios for PTs and OTs