August 25, 2006

2008 ASC payment schedule with 62% of hospital payments is proposed to include blended rates for 2008

In a recent e-mail we sent we have shown you 62% of HOPD straight without blending. Since then CMS has published a blended rate for each code. As per CMS this will be budget neutral. While some organizations are fighting this methodology some are supporting. There are major winners at 62% straight down methodology; however, based on the CMS methodology for 2008 the losses will be less than projected by ASIPP.

Originally, CMS stated that they would also use a blended rate for 2009 however; we are unable to find a 2009 rate in the proposed schedule. In any case, either in 2009 or 2010 the direct methodology of 62% or lower will be effective. Further, there are also mistakes in the published schedule which will be corrected. In addition, we really can’t be celebrating that losses are less, as some have done, and some are mourning because their expected raises are not there. These are only proposed payment rates and they may change significantly when the final rule comes.

Enclosed please see a table showing HOPD 2007 proposed rates and HOPD ASC proposed rates for 2007. Further, we also have inserted blended rates as proposed by CMS for 2008 and also I wanted to have everyone see how it would be if they went down a straight 62%. For the table illustrating showing all of them, click here.\

For more information on the proposed 2007 & 2008 changes go to: http://www.cms.hhs.gov/ASCPayment/06_CMS1506P.asp#TopOfPage

CPT Category III code 0027T to expire Dec. 31, 2008 

The AMA has notified ASIPP that CPT Category III code 0027T Endoscopic lysis of epidural adhesions with direct visualization using mechanical means (spinal endoscopic catheter system) or solution injection including radiologic localization and epidurograph will expire Dec. 31, 2008.

According to the CPT process, because Category III codes are designated as temporary codes for emerging technology, services, and procedures, they are archived 5 years from the date of publication of the CPT codebook, if the code has not been accepted for placement in the Category I section of CPT.

See AMA Letter

The HHS Office of Inspector General releases guidelines for evaluating false claims acts

On Monday the HHS Office of Inspector General released a notice of publication of OIG’s guidelines for evaluating state false claims acts. The guidelines went into effect on Aug. 21, 2006.

See the Federal Register Notice: http://oig.hhs.gov/authorities/docs/06/waisgate.pdf

Comprehensive Imaging Review Course in IPM – Deadlines near

The cut-off date for discounted hotel reservations is today, August 25. You must make your reservations with the Coronado Island Resort by 5:00 p.m. today in order to receive the special ASIPP room rate. Make your reservations today!

In order to receive the early course/exam registration discount date you must register by Aug. 30, 2006. Don’t miss out on this Comprehensive Imaging Review Course in Interventional Pain Management on Sept. 14-16 and the ABIPP Competency Certification in Fluoroscopic Interpretation & Radiation Safety (exam for IPM physicians only) on Sept. 17. This 3-day Comprehensive Imagining Review Course is planned as a CME activity to prepare physicians seeking competency certification or as an in-depth review in fluoroscopic interpretation and radiation safety.

For more information or to register online go to: http://www.asipp.org/meetings.htm

October Cadaver Workshop and Review Course

Make plans to attend the next Interventional Techniques Review Course and Comprehensive Interventional Cadaver Workshop on October 21-22, 2006 in Memphis, TN.

The Review Course is planned as a CME activity to prepare physicians seeking board certification by ABIPP or as an in-depth review of Interventional Techniques. Additionally the Review Course will be based on the specifications of the Cadaver Workshop and will assist in preparation for ABIPP Part I or Part II (FIPP) examinations.

Learn more about the course, workshop, and hotel information and REGISTER ONLINE at: http://www.asipp.org/meetings.htm

Medicare glitch gives $50 million mistaken refunds

WASHINGTON (AP) — The Federal Government has erroneously reimbursed about 230,000 Medicare recipients for monthly premiums they paid this year for prescription drug coverage. The refund will undoubtedly cause confusion, particularly because it comes with a letter that mistakenly instructs seniors that their monthly premiums will no longer be deducted from their Social Security check.

CMS Administrator Mark B. McClellan, MD., PhD said people who get the check need to know two things, that the money must be returned and that their prescription drug coverage will continue. The error occurred as McClellan's agency updated the Social Security Administration about various changes in coverage that beneficiaries had requested. For instance, beneficiaries contact CMS because they want to switch plans or change how they pay their monthly premiums. CMS contacts Social Security officials because the changes often require an adjustment in the amount deducted from a beneficiary's checks. In this instance, the wrong information was transmitted, McClellan said.

See New York Times article

Medicaid payments lowered legally

In a spilt decision the New Hampshire state Supreme Court ruled on Tuesday the state Health and Human Services commissioner can decide how much the state will pay for drugs used by Medicaid patients and can audit pharmacies to assure they are giving Medicaid the lowest possible price.

See Portsmouth Herald Article