Belated Medicare Update Must Be Implemented By July 28

As directed by the Centers for Medicare and Medicaid Services (CMS), Medicare contractors must implement the belatedly updated Medicare Physician Fee Schedule (MPFS) by July 28.

The 2.2 percent update approved June 25 must be applied to services paid as of June 1 and through at least Nov. 30.

Medicare contractors will use updated payment files to process new ASC claims and adjust previously processed ASC claims for dates of service on or after June 1, 2010, that are brought to their attention.

According to the CMS announcement, "ASCs who may have received an incorrect payment determination for certain services furnished on or after June 1, 2010, through the implementation of the July 2010 [Ambulatory Surgery Center Fee Schedule] may request contractor adjustment of the previously processed claims."

To read the CMS MedLearn article describing the mid-year update to the HCPCS codes, click here.

ASC Medicare Payments Frozen

In the Centers for Medicare and Medicaid Services (CMS) rule scheduled to be published August 3, 2010, ambulatory surgery centers will receive a 1.6 percent payment increase. The update will net a zero percent change when the productivity adjustment included in the health care reform legislation is taken into account. Payment rates have therefore been frozen in seven of the last eight years.

In spite of prodding from surgery center allies including 32 members of the House of Representatives, CMS determined to adjust ASC payments based on the Consumer Price Index rather than the more appropriate hospital market basket.

SGR Temp Fix Finally Approved

The House of Representatives passed H.R. 3962 June 24, which provides a 2.2 percent Medicare fee schedule update for physician services through November 2010. The bill passed by a bipartisan vote of 417 to 1. Since the same legislation passed the Senate last week, the bill will be sent to President Obama’s desk to be signed into law.

The 2.2 percent update provided by H.R. 3962 would replace the 21 percent Medicare cut currently in effect, and be applied retroactively to claims for services provided on or after June 1.

Any details we receive on procedures the Centers for Medicare and Medicaid Services will use to retroactively adjust June claims that have already been paid at the lower rate will be sent to the AACU Membership.

Congress Must Act NOW to Keep Medicare Patients Safe!

In keeping with a tradition of last-minute Congressional reprieves, the Senate agreed to freeze a Medicare pay cut to doctors the day it was scheduled to go into effect. The short term payment fix must pass the House now. We must move fast!

The Senate decided to pass a nearly six-month freeze of a 21.3 percent cut to physicians payments from Medicare, just as the Centers for Medicare and Medicaid Services resumed processing payments after an 18-day hold.

While the six-month extension is not what we want, it is critical something is done in order allow doctors to continue to treat their Medicare patients properly until we can come to an agreement on a permanent fix.

We are calling on all AACU Members to contact their Representatives and tell them to Vote YES on the Senate’s bill and commit to FIXING the SGR once and for all.

UPDATE: Least Costly Alternative (LCA) in Local Coverage Decisions

The Centers for Medicare and Medicaid Services (CMS) determined they will no longer enforce least costly alternative (LCA) policies as of 4/19/2010.

CMS Contractor Pinnacle Business Solutions, Inc. reports on their website:

Based on instructions from CMS, Local Coverage Determinations (LCDs) in which ‘Least Costly Alternative’ provisions exist are to be changed. The following LCDs will be retired (AR/LA Part B), not finalized (AR-Part A), or removed from comment period (LA/MS Part A) with an effective date of 4/19/2010.

1. AC-07-004 LHRH Analogs, Agonists, and Antagonists for Treatment of Malignant Neoplasm of the Prostate (L26245)

2. ARA-07-004 LHRH Analogs, Agonists, and Antagonists for Treatment of Malignant Neoplasm of the Prostate (DL30746)

3. PBSI-A-10-045 LHRH Analogs, Agonist, and Antagonists for Treatment of Malignant Neoplasm of the Prostate (DL31046)

This change comes after a December 2009 court ruling that sided with a Medicare beneficiary regarding her treatment option. The case of Hays v. Sebelius involved Medicare denying a patient a prescribed treatment for her serious lung disease. Medicare, in complete contrast to the physician’s advice, decided to pay for the Least Costly Alternative (LCA). The court ruled in favor of the plaintiff and the decision by Medicare was overruled.

Therefore, effective, 4/19/2010 all Medicare carriers will reimburse LH-RH Analogs at the CMS published quarterly provider update associated with their individual J-Codes.