November 24, 2010
Medicare Physician Reimbursement Cut Delayed Again - But Only For One Month |
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WASHINGTON - In yet another good news/bad news scenario, lawmakers once again postponed a 23 percent reduction in Medicare reimbursements to doctors - but only for one month.
Senate Finance Committee Chairman Max Baucus (D-Mont.) and Sen. Charles Grassley (R-Iowa), the committee's senior Republican, announced on Thursday an agreement to put off the pay cut related to the Sustainable Growth Rate (SGR) from December 1 to Jan. 1, 2011. The Senate approved the measure by voice vote on Thursday; the measure has yet to be voted on by the House, which is in recess for the Thanksgiving holiday.
Healthcare Finance News |
New Reimbursement Pattern for 2011 with Impending Cuts, Changing Codes, and New Congress |
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While health care reform is taking its toll on all of us, interventional pain management faired better than many other specialties. As you have seen, our practice expense has increased and continues to apply towards physician and office procedure payment system. The case with ASCs is a different issue. The following comments are from ASIPP Chairman of the Board Laxmaiah Manchikanti, MD:
Impending Cuts: Personally, I do not believe that the cuts will be implemented. There will be a temporary fix, followed by another intermediate fix of probably 1 to 2 years. Meanwhile we will continue to express our displeasure with the system to the Congress. Most of the left wing folks, liberal media, and even the debt committee are recommending going through with the cuts in order to save Medicare. However, they are not fully considering what will happen to Medicare patients if this does happen.
Physician Payment Rates: Based on the final schedule which was just released, we are seeing increases of as much as 15% from 2010 without a cut for the most commonly performed interventional techniques. Of course for some, the range is much lower, but all in all, we are seeing an increase rather than a decrease. This is in response to our practice expense survey. Maybe we can say that payments are bouncing back after our years and years of hard work. As you well know, transforaminal epidural injections are bundled with fluoroscopy effective January 2011. However, there is increase in the reimbursement for the physician payment and also the office portion. For the final physician payment rates for interventional techniques, please click HERE.
Payment Rates for Office Procedures: Similar to physician payment rates, we are seeing increases for the procedures performed in an office setting as high as 20% for some procedures, but overall there are increases rather than decreases. Once again, this is related to practice expense survey for interventional pain management. Please note, the office expenses are listed under non-facility and physician payments are listed under facility and non-facility. For the final physician payment rates for interventional techniques, please click HERE
Ambulatory Surgery Center Payment Rates: The Ambulatory Surgery Center has taken a beating as in previous years. However, it is better than expected; the most commonly performed procedures take a hit of less than 1% compared to 2010. However, almost 12% compared to 2007. Add-on codes are another story. The reductions are substantial for this with approximately 21% reductions from 2010 and almost 70% reductions from 2007. Some codes have seen minor increases. In addition, CMS also has mistakenly calculated lower reimbursement for cervical radiofrequency neurotomy despite multiple requests from us. We will contact them again. Finally, we have been unsuccessful with our fight for the inclusion of discography in the ASC list, even as an office procedure. Consequently, if discography is performed on Medicare patients in surgery centers, they will be paid at the physician payment rate as if it is performed in a facility for the physician with no payment for the facility at all. On another note, for procedures such as implantables, there will be substantial increases, especially compared to 2007, even though increases are minor compared to 2010. However, the question remains if this will cover the expenses as there is no separate payment for durable equipment. For the ASC payment rates for interventional techniques, please click HERE
Hospital Outpatient Department Payment Rates: As usual, hospitals have done better with significant increases from 2010 for almost all procedures of approximately 6%. But, some of the procedures have been wrongly valued, which also spilled into ASC payment system. Once again, we will be contacting them in the effort to correct this. For the HOPD payment rates for interventional techniques, please click HERE |
Reserve Your Spot Today for 2011 Review Course and Cadaver Workshops |
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Registration is now open for the February and April Comprehensive Review Course and Cadaver Workshop in Interventional Pain Management. Both courses feature Basic, Intermediate, and Comprehensive Interventional Pain Management Examination section levels. The courses will be held on February 18-20 and April 8-10 in Memphis, Tenn. In order to maintain an optimal participant/instructor ratio, space in both courses is limited so please register early to assure a spot in the course and in the level of your choice.
During the 2½-day Comprehensive Review Course and Cadaver Workshop, you can improve existing skills and/or learn new techniques. You will have the opportunity for personal interaction with our distinguished faculty comprised of excellent teachers and lecturers. It is always our goal is to create a thorough and compelling educational experience for you.
Whether you have been practicing interventional pain management for many years or are new to the field with basic skills, we are confident you will find these courses and workshops to be beneficial to you in your practice. With the ever changing dynamics in healthcare and in the specialty of interventional pain management, it-is essential that we continue learning and exploring new procedures and techniques in our specialty.
Both courses will take place at the Marriott Memphis, 2625 Thousand Oaks Boulevard (901-362-6200) on Friday. Ask for the ASIPP reduced room rate of $129 when making your accommodations. On Saturday and Sunday we will transport you the Medical Education and Research Institute (MERI) for a hands-on learning experience.
Click HERE for February Registration
Click HERE for April Registration
Register for 2011 Course Today |
FDA Drug Safety Communication: FDA Recommends Against the Continued Use of Propoxyphene |
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The U.S. Food and Drug Administration (FDA) is recommending against continued prescribing and use of the pain reliever propoxyphene because new data show that the drug can cause serious toxicity to the heart, even when used at therapeutic doses. FDA has requested that companies voluntarily withdraw propoxyphene from the United States market.
Propoxyphene is an opioid pain reliever used to treat mild to moderate pain. It is sold under various names as a single-ingredient product (e.g., Darvon) and as part of a combination product with acetaminophen (e.g., Darvocet).
FDA's recommendation is based on all available data including data from a new study that evaluated the effects that increasing doses of propoxyphene have on the heart (see Data Summary below). The results of the new study showed that when propoxyphene was taken at therapeutic doses, there were significant changes to the electrical activity of the heart: prolonged PR interval, widened QRS complex and prolonged QT interval. These changes, which can be seen on an electrocardiogram (ECG), can increase the risk for serious abnormal heart rhythms. FDA has concluded that the safety risks of propoxyphene outweigh its benefits for pain relief at recommended doses.
FDA |
Drug Maker Agrees to Withdraw Pain Pills From Market |
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WASHINGTON--The maker of pain pills Darvon and Darvocet agreed to take the products off the market because of concerns the drugs increase the risk for serious abnormal heart rhythms, the U.S. Food and Drug Administration said Friday.
Darvon, which contains the active ingredient propoxyphene, has been on the U.S. market for more than 50 years and was developed by Eli Lilly & Co. Later, the company combined propoxyphene with another pain ingredient, acetaminophen, and sold the pill as Darvocet.
Wall Street Journal |
Multimillion Dollar Settlement Reached in Tampa, Florida Medicare Fraud Case |
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The United States Department of Justice announced on Nov. 16 a settlement in Debra Maul, State of Texas, Commonwealth of Massachusetts and the State of Florida v. Ameritox, LLC et al., C.A. 08:07-cv-00953-t-26eaj. This action was filed in May of 2007 in the U. S. District Court in Tampa, Florida and alleged a number of violations of the federal False Claims Act by the laboratory Ameritox of Baltimore, Maryland. The most significant allegations related to Ameritox's practice of paying physicians for each patient urine sample collected by the physician and sent to Ameritox for testing, as well as improper use of collectors in physicians' offices. The settlement requires Ameritox to pay $16.3 million in resolution of all issues.
The plaintiff, Debra Maul, worked for Ameritox as a Senior Sales Representative and tendered her resignation on May 31, 2006. Ms. Maul reported her concerns to both Ameritox and the OIG while still employed by Ameritox. Attorney David J. Linesch of The Linesch Firm in Palm Harbor, Florida, represented Ms. Maul. The Linesch Firm specializes in employment law and whistleblower cases.
Miami Herald |
Bundle Webinars on Coding for AMA and CMS Set for Dec. 7, Dec. 14 |
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ASIPP is pleased to offer you the opportunity to attend a bundle of webinars that will explain the RVU changes in the Medicare Physicians Fee Schedule and how they impact the most frequently performed interventional procedures and services. The two webinars will both be at 10 am EST. On Dec. 7, the topic will be AMA Coding and then on Dec. 14, the topic will be CMS Coding.
Joanne Mehmert, President of Joanne Mehmert & Associates, LLC, in Kansas City, Missouri, has specialized in consulting for coding, billing and reimbursement issues for Anesthesia and Pain Management for the past 10 years. A Certified Operating Room Technician and a Certified Professional Coder, she brings "walk in your shoes" experience directly to physicians' staff as well as an understanding of the clinical aspects of the practice. Memhert will update you on the various government audit tools, who they are and what their goals are.
With the drop in fees and all payers creating much more strict medical policies before they will pay for interventional procedures, you can't afford to fall behind in the coding changes. We will include AMA coding decisions and 2010 coding news affecting IPM.
Cost for both webinars is $195. The courses have been approved for a total of 1.5 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Register Today! |
Hospitals, Doctors, Patients Try to Cut Radiation from CT Scans |
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DEARBORN, Mich. - National attention over patients receiving potentially harmful doses of radiation from CT scans and other medical imaging tests has led some hospitals to take more measures to reduce radiation exposure, particularly for those facing repeat scans.
To safeguard patients, many are designing new guidelines as well as purchasing new scanners that lower radiation doses.
Oakwood Hospital here has spent nearly $4 million this year on new CT machines and upgrades.
USA Today |
N.J. Pain Doc Charged With Bilking Medicare for Nearly $52M |
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If his Medicare claims are to be believed, pain management physician Amgad Hessein, MD, worked every day of the week between 2006 and 2007, sometimes for more than 24 hours in a single day. All told, Dr. Hessein's pain management practice billed Medicare for nearly $52 million over a 4-year-period, say law enforcement authorities, who arrested the doctor and his brother last week on charges of 2nd degree healthcare claims fraud and conspiracy.
An investigation into Dr. Hessein's Advanced Pain Management Specialists in Union County, N.J.,revealed that, between 2006 and 2009, he "had billed for treatments for which he did not have the equipment to perform, would bill patients for higher level, more costly treatments than were actually performed and would bill for visits when patients were not even in the office," said Union County Prosecutor Theodore Romankow in a press release.
Outpatient Surgery Magazine |
Rules Eased for Some Health Plans |
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WASHINGTON-Amid pressure from employers, the Obama administration on Monday loosened rules for bare-bones health-insurance policies. It marks one of the administration's biggest steps to peel back regulations that big business found onerous under the health- care overhaul. McDonald's Corp. had warned regulators it might have to drop its health-insurance plans for 30,000 hourly workers unless it got an exemption for these policies, which have low premiums but also limit payments for medical costs.
Wall Street Journal |
2010 Interventional Pain Management Practice Survey Now Online |
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Please remember to take part in our 2010 Interventional Pain Management Practice. We have established an online version here to make participation easier and more convenient for you here: http://www.surveymonkey.com/s/PFSCP8R. As the Interventional Pain Management community is small and select, we must depend on one another for this key practice information. Our purpose is to provide the ASIPP membership with timely information, thereby helping physicians compare practice performance with their peers. The higher the level of participation, the more value the survey will have to our membership.
This survey has been previously distributed at review course meetings and through the ASIPP eNews. The deadline for participation has been extended several times. Unfortunately, we did not receive adequate response to create a reliable profile of our members' practice activity. If you have already completed the survey and submitted the results, they have been recorded and will be included in our 2010 Practice Benchmark Report. You do not have to re-submit. Please contact the ASIPP Staff at asipp@asipp.org if you have any questions about the survey.
Take online survey now! |
Physicians Wanted |
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Visit the ASIPP Web site to find available positions for IPM physicians.
Physicians Wanted |
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Copyright © 2008
American Society of Interventional Pain Physicians ®
81 Lakeview Drive, Paducah, KY 42001
Phone 270.554.9412, Fax 270.554.5394
E-mail asipp@asipp.org
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